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[Resolved]  Mediclaim (New India Assurance) — Non settlement of claim

I am insured under mediclam insurance policy of New India Assurance Co. Ltd whose TPA is MD India Healthcare Services Pvt. Ltd.
I was hospitalised from 6th to 9th January 2008 whose documents for claim settlement were submitted in the office of TPA. After talking to them many times and even going personally several times, i am not getting any responsible answer from there.Every time I am told that your claim will be settled shortly.But after a time span of 5 months, on the one way they are telling that your file has been misplaced by us. On the other way when I complained online on their site-www.mdindia.com, they are telling that your disease is pre existing.How is it possible?? How a person without going through the policy documents can say that. When we told them that the disease DM is not Pre- Existing from 5 years, they are not ready to check the records. I Am insured since last more then6 years and I was not suffering from DM at that time.
Sir, this kind of attitude is not expected from an Esteemed Co. like them.
I hope I'll get some help through your forum.
Complaint marked as Resolved 2020-08-14 00:14:37
Complaint comments  15 CommentsShare0Tweet0

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settlement of claim
I am insured under mediclam insurance policy of New India Assurance Co. Ltd whose TPA is MD India Healthcare Services Pvt. Ltd.
I was hospitalised, whose documents for claim settlement were submitted in the office of TPA. After talking to them many times and even going personally several times, i am not getting any responsible answer from there.Every time I am told that your claim will be settled shortly.But after a long time i dinot got my claim.
My name is Mr Shripal Saini and Policy No is 311502/81/07/[protected]. I got the ID nO. - N[protected] against mediclaim.

Sir, this kind of attitude is not expected from an Esteemed Co. like You.

I hope I'll get my medi-claim cheque through your forum.

Please intimate me on my Id : [protected]@yahoo.co.in

Thanks & Regards

Shri pal Saini
I had one similer dispute against the said Co. I am granted claim by Dist. Con. Forum. with interest and cost of legal dispute. State Commission also rejected Companies appeal with cost.
You may try your dispute with Dist. con.Forum. See result.
Best of luck.
Sir,
1.If your claim has not been paid till now, then
2.Request the Insurers /TPA to supply you attested photocopy of your submitted claim papers in toto
3 If, that request is not met with then, first
you approach the `Grivance Cell'
4.I[censored]nsatisfied, Ombusman of your state/region
5.Finally the Hon. Dist.Consumer Forum
Meanwhile,
Keep a set of photocopy of your Policy since 1st policy, showing continuity
Keep a set of photocopy of your claim papers
Sir,
1.If your claim has not been paid till now, then
2.Request the Insurers /TPA to supply you attested photocopy of your submitted claim papers in toto
3 If, that request is not met with then, first
you approach the `Grivance Cell'
4.I[censored]nsatisfied, Ombusman of your state/region
5.Finally the Hon. Dist.Consumer Forum
Meanwhile,
Keep a set of photocopy of your Policy since 1st policy, showing continuity
Keep a set of photocopy of your claim papers
Dear Sir
I was hospitalised in NC Jindal Hospital Hisar and later in City Hospital of Ganga Ram Hospital for Gullian barr Syndromme an outcome of Chicken pox. The TPA Raksha has declined to pay for the expenses because they are linking it with cervical spondilytis whereas the doctor has clearly said that it has no relation with any earlier disease. I will be gratefull if some help is extended. My Member ID is N[protected] and policy no. 353401/34/08/11/00000091
bharti sharma
can i get claim for missed abortion in 8th week. missed abortion means fetus died in womb as natrral rejection and required to remove by instruments with anestesia and 1 day hospitalization.
The original claim amount of my policy no.[protected]-00008910. was Rs 23834, whereas my claim settlement was done only for Rs 17259, leaving a balance amount of Rs 6575. I request you to please let me know the reason for the difference in my claim amount, as per rule the clause applicable to my claim is 2.2, as I was admitted to the ICCU ward, the papers are already sent.
Hence kindly look into the matter seriously, and reply me back at your earliest. My T.P.A. is Raksha TPA. I will be very much obliged to you for doing the needful as soon as possible.

THANKING YOU,
YOURS RESEPECTFULLY,
MR.BHARAT KUMAR N RAWAL.
I am in America at present.My agent Snehal Shah has informed me that you have sanctioned only Rs.17500. The cheque was sent to my residential address in Vadodara 503, Tirth Apts. Pashabhai Park, Racecourse, but returned back.The claim was for my wife's knee replacement by Sheetal Vaidya in Feb.2009.Name of my wife is Hema Desai.
You may hand over the cheque to Snehal Shah Insurance Agent for credit in Central Bank of India Racecouse A/c [protected] or you may directly credit the cheque in the said bank account.
I am ready to help you in this matter. Contact me on [protected]
Settlement of Mediclaim filed with
Raksha TPA Pvt. Ltd., Faridabad

Member ID : NO56890
Pol. No. : 310604/34/09/11/0000088
Insured person : Sat Pal Malhotra
Claim Ref. No. : [protected]
Claim Amount : Rs.13273/-


I am a Senior citizen and have been getting Mediclaim policy from The New India Assurance Co Ltd., Nehru Place, New Delhi, for the last about 15 years.

My wife was admitted in the National Heart Institute from 01-09-09 to 03-09-09 and as such, the Mediclaim was sent under registered cover to Raksha TPA Pvt Ltd., Faridabad, on[protected] attaching therewith all the relevant supporting documents/Cash Receipts.

Needless to mention that the letters received from Raksha TPA, Faridabad were properly attended to and replies were sent under registered cover, Postal Receipts retained, but sorry to mention that, when we met all their requirements and furnished proper receipts again and again, without caring to go through their file and the case history, they closed the file, mentioning that till date no proper reply received, when all Cash receipts sent under registered cover are with them, Postal receipts retained. They being a reputed company, it is not understood as to how can they can close the file without settling the mediclaim.

In view of the above, I approach your good office with a request to take up the matter with Raksha TPA Faridabad and arrange to get our mediclaim settled and payment made to us urgently.

Scanned copies of some of the important documents are attached. in case need be, I can send photocopies of all the communications exchanged together with copies of the Bills/Cash Receipts.

Looking forward to hearing from your end enabling me to go ahead.

Regards
S.P. Malhotra
L-2/142=B, DDA Flats,
Kalkaji, New Delhi 110019
Mob.[protected]
I have applied for claim upon my minor operation on 12 th of march i was assked to get my claim number by serch which i am not able to .My policy no.is 712500/34/09/11/00000446 and my membership ID no is N[protected] pl help to get my claim no and status
Dear Sir,

I have Medical Insurance policy behalf of my employeer.
I have submitted the claim form through TPA.Now TPA is asking Hospital REGN Number. The Hospital do not have registeration number .The insurance company share the policy details to us in that rules there is no where talk about Hospital registeration number, they r talking about network hospital And non work hospital.



Can you help me In this case How i can Get my claim amount.
Sekar
[protected]
where is the hospital situated is it city or in rural areas for what he was admitted and how many beds are there in that hospita and regular doctor is available in that particular hospitals and have you submitted the claim form signed by the doctor.
The hospitalauthorities would have registered with that particular TPA for claim settelement collect and submit the same or ask the insurance co to interviene and do the needful.at the earliest .
bye oza. [protected]
hero honda pleasure non settlement of claim
Non settlement of mediclaim

I Gopal Yadav took mediclame policy from New India Insurence Company-nehru palace, tonk road, jaipur (Raj) from last 7 years of which TPA is from Vipul TPA ajmer road, jaipur.I was hospitalized on 18 august 2011 of pyles(pistola)at Rjdhani Hospital, bhagvandas road, jaipur and all the billes of operation are submited to insurance company on 24 august 2011 & additional bills on 8 oct 2011 but my clain is stil due from last 4 month.I went to insurancr company many times and had meeting with the manager and he is not answering my question about claim and not giving my clame amount.So i request u to please tell to the company about my due amount of mediclame.

My Mediclame policy No.-[protected]

File N0.-12RB02NIH0600

contact: [protected]@gmail.com
mobile no. [protected]

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    Company:Mediclaim (New India Assurance)
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