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[Resolved]  Health Insurance : Raksha Tpa — Claim denied in spite of timely submission of papers


I have a medical / health policy from New India Insurance company .
Details of my Policy are

Member id : N086721
Name : Chander Mohan Chopra
Policy no : 312000/34/07/11/00000556
Claim amount : Rs16885

I was admitted in the hosiptal on 21-aug-2008 to 23-aug-2008 and had a put a claim to Raksha TPA on 8th Sep'08 since my cashless hospitalization form was not approved by raksha during my stay at the hosipital.
In October I recieved a reminder from Raksha asking for the following papers:
1.TROP-T Report in original.
2.Original report during hospitalisation. 3.Provide BP charting of the patient for course during
4.Break up in details for drugs charges of Rs.154/- in main hospital bill.

I had submitted all relevant documents by 12th Nov '08 ( courier reciept available )as asked in the reminder mails by Raksha yet my file was closed on 19th Nov'08

The courier company name was : On dotcouriers & cargo ltd and docket no was :[protected] which was receieved before the final reminder expired .

After writing on thier website several times, someone from Raksha finally contacted me in Jan'09 to discuss this case. After a detailed discussion i was asked to visit my branch office in Bikaji Kama place, New Delhi to get a File re opening letter from New India Insurance office. My brother Visited the following address
The New India Assurance Co. Ltd.
Ansal Ch-1, B-401
Bhikaji Cama Place
New Delhi

On the visit to New India Insurance office my brother were asked to get in touch with the R.O in C.P, New delhi and was also told that they have no informantion on file closure of this policy number.

I wrote an email to the Divsional manager of Bhikaji cama place branch (Mr Amit Mishra :DO-312000) asking for help who promptly responded nad forwarded another mail to Mr.Gupta stating that they have not recieved any papers from Raksha. Its been a week today and Mr. Gupta has not bothered to respond to this query.

Finally status is

Raksha : wants a re opening letter from THE NEW INDIA ASSURANCE CO. LTD
New india Insurance : write an email to Mr gupta in RAKSHA TPA who does not repsond
customer : Is stuck between insurance company and TPA

Its been 5 months i have been trying to get this case settled but there is no end to my waiting.

Kindly help !!

Chander Mohan Chopra
Complaint marked as Resolved Aug 14, 2020
Complaint comments  1 CommentShareTweet


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    +91 12 9428 9999 [Faridabad]
    +91 22 6787 6666 [Mumbai]
    +91 80 4283 9999 [Bangalore]
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