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[Resolved]  Insurance - Cricescover — refuse the claim

Subject: Regarding Misrepresentation of Facts to sell the Insurance Policy and thereafter acting dishonestly to gain advantage and personal benefits.

Dear Sir,

I would like to bring it to your kind notice that on 4th of September, 2008, I had bought Health Insurance Policy “CRISIS COVER" Policy No: 09847197 from ICICI Prudential with Risk Cover of Rs. 6 lacs (Death & Critical Illness Benefit of Rs. 3 Lacs each) and accordingly paid a premium of Rs. 4363.00 only vide Cheque Number 569836 dated 04.09.2008.

Mr. Rajat Chabra (Agency Manager) sold this policy under his sister’s code (Ms Rupali Chabra advisor ICICI Prudential). During this he also told me that claim will be paid to me if mentioned diseases in the Policy Cover happened to the policy holder.

Inspite of paying the premium in the month of September 2008, I never got my Policy Documents. I contacted Mr. Rajat Chabra in the month of November 2008 regarding the Policy document which I had not received till date. On repeated requests about delivery of Policy Documents, I was told that my policy documents have been dispatched to ICICI Prudential Jalandhar Branch and from there Mr. Rajat Chabra would personally handover the same.

Unfortunately I got acute heart attack on 8th December 2008 almost 4 month after I had bought the policy from ICICI Prudential. My Angioplasty was done at Escorts Hospital Delhi. I informed about my treatment to Mr. Rajat Chabra (ICICI Prudential) on 17th of December.

I again informed Mr. Rajat Chabra that I have not received any documents till date regarding my policy. However I was also informed by Mr. Rajat Chabra that he is going to inform the claim department through email regarding my claim and assured me that my claim would be processed and settled without any delay.

Mr. Rajat Chabra came to my house in the month of January 2009 and I handed him over my medical papers for filling the claim against my above stated policy no: 09847197. For the claim settlement Mr. Rajat Chabra even witnessed the documents and he informed his Branch Manager Ms Jag deep Kaur about my claim. I personally also spoke to the Branch manager and she said my claim will be settled in no time and I need not worry about anything.

After submission of my documents for claim, Doctors of ICICI PRU called me from their Mumbai office and enquired about the disease and its treatment. They talked to me over the phone for 3 times, and asked me to FAX the angioplasty reports which I did. After 15 days Mr. Rajat Chabra came to my house and handed over an A/c payee Cheque for Rs. 3883.00 only as the advance payment from the total claim amount and also informed me that the pending amount would be dispatched at the earliest.

However when I did not receive the pending payment of the claim amount and when Mr. Rajat Chabra stopped picking my phone call, I personally visited the branch office in Jalandhar on 21st August 2009. However after visiting the Branch Manager Mrs. Swatee Gupta and after explaining the whole situation, I was shocked to learn that ICICI Prudential had terminated my Policy and the Cheque that I had received through Mr. Rajat Chabra was not the advance claim amount but the premium amount that I had given to the ICICI at the time of start of my policy.

I was also informed by the ICICI Prudential Branch Manager Mrs. Swatee Gupta that the said policy had a waiting time of 6 months for any claim amount to be settled and if any claim is submitted by the party within 6 months of the date of issue of the policy, the same would not be entertained and policy would be terminated. Whereby when Mr. Rajat Chabra the employee of ICICI Prudential approached me during the process of sales and during the time of filling of my claim, I was very clearly told me that my cover will start from day one for the mentioned diseases.

Even when I told ICICI Prudential regarding happening of this disease, they misguided me and accepted my claim papers. Even at the time of filling my claim, I was told that my claim will be fully settled without any delay and deduction.

But it did not happen as ICICI Prudential denied my claim and returned my premium and terminated the policy.

It is worth mentioning here that I was only provided my Policy Documents on 21st August 2009 after Mrs. Swatee Gupta Branch Manager of ICICI Prudential Life Insurance asked Mr. Rajat Chabra to do so and he personally came to my house to deliver the documents.

It has come as a big shock and surprise to me that if the employees of ICICI Prudential Insurance Company (namely Mr. Rajat Chabra) were fully aware of the waiting period of Insurance Policy, why did Mr. Rajat Chabra who is Permanent Employee of ICICI Prudential Life Insurance sign and witness my claim papers (attached along with for your ready reference) in the month of January 2009 (4 months after the starting date of the policy) and inform me that my claim would be settled.

In whole of the process I was mentally upset and harassed by ICICI employees. They misguided me from the day one when I bought this policy; they represent themselves as the ICICI Employees one of the most renowned Insurance Company of India but do not have the complete knowledge of the product they sell.

ICICI Insurance Company does not care about any of their customers; their sole aim is to sell the Insurance Policies by cheating their clients, giving them wrong information, misguiding them and acting in a dishonest way to take advantage and for personal benefits.

While my doctor told me for complete stress free environment and rest at home for at least one month. But during the entire process of settlement of claim with ICICI Prudential, I along with my family members have been harassed both mentally and physically. Time and again they keep on misguiding me about my claim that it will be settled.

Now this is the time when I actually require the insurance cover but instead ICICI Prudential terminated the policy for no fault of mine and further I am unable to get the same policy again. I am a bread winner of the family, have two school going children and wife who all are depend upon me. What will happen to their education and family expenses including my daughter’s marriage? If any unfortunate event happens to me, who will bear my medical expenses and I will be into huge financial problem, I am at critical stage at this point of life because of my Angioplasty which has already been done twice.

To resolve the problem, I would appreciate your decision to compensate for mental harassment, wastage of time, stress, upset family environment, insurance cover denial, cheating, misguiding, and giving wrong information at the point of sale and at the time of filling of the claim papers, hiding the facts and misrepresentation, with following:

(1) Financial compensation from ICICI Prudential Life Insurance of Rs. 10 lakhs to be provided to me for mental harassment, wastage of time, stress, upset family environment, insurance cover denial, cheating, misguiding, and giving wrong information.
(2) Insurance Cover by same policy from ICICI Prudential Life Insurance of Rs 20 lakhs to be given in my name for which I will pay the premium.

Enclosed are copies of my records (Policy Documents, Medical Reports and Claim Settlement Form duly signed and attested by Mr. Rajat Chabra Employee of ICICI Prudential Life Insurance).

I look forward to your reply and resolution to my problem.

Please contact me at the following address and telephone number:

Mr. Rishipal Singh
S/o late Shri Isam Singh
H.NO. 132
MIG FLATS Urban Estate Ph-1.
Telephone: [protected], [protected]

Address of the Concerned Branch of ICICI Prudential Life Insurance:

ICICI Prudential Life Insurance Company Limited
5th Floor, Shakti Tower,
Near BMC chowk
Jalandhar City
Telephone Number:[protected]

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Aug 14, 2020
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