Mediclaim Policy Of Oriental Insurance Co. Ltd. — Denial of cashless benefit by Misbehaviour & Misconduct of employee of the Oriental Insurance co. Ltd., Kharagpur extn. counter of Midnapore Br. O
Kharagpur, West Bengal, India
Oriental Insurance Co. (O.I.C.) Mediclaim policy No. 311990/48/2009/90 (Second year), validity from[protected] to[protected] of Proposer: SEEMA MURUGAN for patient: SIVABHARATHI
The chronological account of events in the reported matter since the 9th Dec., 2009:
1.[protected]: The complainant’s elder daughter, SIVABHARATHI, admitted for Punch Grafting VITILIGO surgery at Apollo Hospital, Canal Circular Rd., Kolkata.
2.[protected]: The complainant, i.e. M & N/G of SIVABHARATHI, applies for insurance at the Insurance Desk, Apollo Hospital, Kolkata.
Miss Moushikha, of Insurance Desk, Apollo Hosp., Canal Circular Rd., Kolkata, faxes the cashless request to H.H.S.P.L. (T.P.A. of O.I.C.) at 2-43 p.m. the same day.
3.[protected]: Complainant makes telephonic request for certificate 64VB to Mr. K.Chandrasekhar (employee of O.I.C., Kharagpur ext.n counter, Midnapore Br. Office) several times - each time was verbally abused with indecent language, and threatened with non compliance of request.
4.[protected] &[protected]: Since Telephonic requests/any conversation with Mr K. Chandrasekhar became impossible, SMS-es were sent by the complainant as per details below:
a.11.12.2009 at 15.42.42 with Fax nos. & appeal
b.11.12.2009 at 15.42.53 with Fax no of Apollo.
c. 12.12.2009: repeat request at 14.56.22.
d. 12.12.2009: URGENT request at 15.16.22.
e. 12.12.2009: URGENT request for the same at 15.16.31.
5.[protected]: Finally after more than 48 hrs., certificate 64VB was faxed at 3-49 pm by which time the complainant had undergone IMMENSE mental harassment & loss of dignity on a/c of the verbal assault, misbehavior & deliberate delay in issue of 64 VB by Mr K.Chandasekhar.
6.[protected]: First Email complaint reg. above-mentioned (sl. no. 3 to 5) to CMD, OIC, & all important Officers in the H.O. of O.I.C., New Delhi.
7.[protected]:Hard copy of the aforementioned email complaint (mentioned in sl. no.6) was personally submitted to the nearest Br. Manager, Midnapore Branch, O.I.C. Since the Branch Manager was absent, it was received by Mr Dasarath Mandi & Mr Bikash Gope namely.
8. The two officers (mentioned in sl. no. 7) MISDIRECTED the complainant to submit an application to the effect that Servicing Branch for the Mediclaim policy may be changed from Kharagpur to Midnapore since by this method the customer would no longer have to deal with Mr K.Chandrasekhar directly. And thus the O.I.C. would continue its policy as well as their employee is spared the complaint.
9.[protected]: Since nothing was heard on the compliant from the O.I.C. for one month (w.e.f.[protected], a repeat email was dispatched to the new CMD of O.I.C., (Dr R.K. Kaul) along with important functionaries in the H.O, New Delhi, appealing for justice as in the initial Email complaint of[protected].
10.[protected]: Hard copy of email (mentioned in sl. no. 9) was speedpost-ed to Dr RK Kaul (C.M.D, O.I.C.) with hand written request to inquire into the matter & provide delayed justice.
11.[protected]: In the interim, because of some follow-up telephonic inquiries at the office of the C.M.D., a single line letter was received from the Customer Service Deptt. of the H.O., O.I.C., N.D., stating that the concerned office(s) are "also being asked to expedite the matter & inform (the undersigned) the position directly to avoid delay".
12.[protected]: In view of aforementioned letter (sl. no. 11), the complainant visited the Midnapore Br. office where in the presence of the Br. Manager, she was once again taunted & verbally abused by Mr. K.Chandrasekhar. All this while the manager did not at all try to rescue the complainant, apart from simply assuring her that he would expedite the matter & intimate her their decision of judgment ASAP.
13.[protected]: Three complete months after the undersigned received the letter from the C.S.D., O.I.C., New Delhi, the undersigned visited the Midnapore Br. Office to enquire into the progress of the matter. Since the Br. Manager was absent, the undersigned submitted a letter reiterating her request of[protected], & provided her mob. no. in case the Inquiry Committee would like to contact her for securing the ends of natural justice.
14.[protected]: Since nothing was heard from the O.I.C. (H.O., N. Delhi, since[protected] or B.O., Midnapore), punctuated by follow-up requests & meetings as detailed above in sl. nos. 9 to 13) the customer PERSONALLY met Mr AR Joshi, C.M. C.S.D, O.I.C., New Delhi, & was shown documents to the effect that the Inquiry had been very conveniently closed (since it had been very mischievously turned by the concerned Inquiry Committee / Inquiring office into that of customer Grievance of cashless facility not being provided).
Therefore on[protected], the complainant submitted a fresh appeal to Mr. A.R. Joshi through a hand written letter on[protected] attaching Xerox copies of her complaint letters dt.[protected]sl. no. 6), and[protected]sl. no.14) as requested by Mr. A.R.. Joshi.
Thereafter, once every fortnight, the complainant made a telephonic enquiry with Mr. A.R. Joshi on the progress of the Inquiry, and was verbally assured by the latter that the Kolkata office (Mr. T.K. Chattopadhyaya) was making some sort of Inquiry whose report was awaited.
15.[protected]: Since more than 41 days were over (w.e.f.[protected] & there was nothing to be heard either from the B.O. Midnapore, or the R.O. Kolkata, or the H.O. New Delhi, the complainant dispatched an email (at 854 am) to Dr R.K.Kaul, C.M.D., O.I.C., N. Delhi, with copies to important functionaries of the H.O. (including Mr AR Joshi), reiterating her request for breaking the complete silence on the matter & total deliberate keeping I dark / ignoring the complainant since the initial complaint dt.[protected].
16.[protected]: On a mobile call to Mr A.R. Joshi (at around 11 am) reg. sl. no. 15, the complainant was informed that Mr K. Chandrasekhar had denied all the complaints of mental harassment & verbal assault and that the complainant was “under some sort of confusion” to which the complainant replied by email at 1145 am.
Once again she requested for justice on her Inquiry application pending with the O.I.C. since the[protected].
17.[protected]: At 1143 pm Mr A.R. Joshi sent an email in which the complainant was informed that Mr K. Chandrasekhar was given a clean chit & the complaint was “being closed on the basis of the report of (OIC’s) Dy. Gen. Manager of Kolkata Region”.
18.[protected]: At 246pm the complainant made a very clean & specific complaint of DELIBERATE DELAY (MISCONDUCT & NEGLIGIENCE OF DUTY) reg. the undue delay in issue of certificate 64 VB for more than 48 Hrs. since application which led to extreme mental harassment to the complainant.
19.[protected]: The complainant PERSONALLY met the C.M.D. of O.I.C., Dr R.K. Kaul, at the H.O., New Delhi & made a fervent appeal for securing justice in the matter of mental harassment by Mr. K. Chandarsekhar on a/c of deliberate delay in issue of certificate 64 VB for more than 48 hrs as an issue of misconduct & negligence of duty.
20.[protected]: The complainant dispatched an email to Dr. R.K. Kaul, Mr. A.R. Joshi & other important functionaries of the H.O., New Delhi apprising them of the meeting with Dr. R.K. Kaul & once again appealing for justice.
21. 18.07.2010: Late evening the complainant received a letter from Ms. Indira Mridha (D.M., Haldia, D.O. of the O.I.C.) reg. closure of her complaint since they had “found Mr Chandrasekhar not guilty of the charges labelled” by the complainant.
22.[protected]: Despite having closed the chapter, the above-named (sl. no. 21) tried to reopen the chapter with the complainant by phone calls & sending email that she wanted to discuss the matter in the presence of high level official from Kolkata. The complainant had by this time having suffered IMMENSE HARRASSMENT due to O.I.C dragging its feet & finally hushing up the matter in a totally one-sided Inquiry.
23.[protected]: Complainant applies under the R.T.I ., 2005, to the C.P.I.O. of the O.I.C., Kolkata, for “complete action taken report & all the file notings (in the matter of Mr. K Chandrasekhar’s MISBEHAVIOUR & MISCONDUCT) with all officers of the O.I.C.”
24.[protected]: The S.P.I.O. & R.M. of the O.I.C., Kolkata dispatches a totally incomplete & truncated reply to the above-mentioned R.T.I. application of the complainant.
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