National Insurance Company — Claim not compensated

Subject: Pending claims with M/s. National Insurance Company
Reference: Health Insurance Policy number: 250700/48/08/[protected]
Claim No: NI/INDV/122008/00170833
Claim No. : NI/INDV/32007/00139868
Dear Sir,
We are sorry to request your precious time for matters like these but after more and enough correspondence with M/s.National Insurance company and TPA M/s.E-Meditek Solutions (IRDA License no:007), we are left out with no other option other than seeking your kind help.
The attached email excerpts are documentary evidence of how TPA M/s.E-Meditek makes demands for unnecessary documents, the significance of which are unknown to the Insurance Company as well.
It has been more than 1.5 months for claim no.1 and more than a year for claim no.2 but we are yet to receive compensation in spite of submitting genuine sufficient documents.
Senior officials like Dr.M.C Agarwal (CRM Chief, National Insurance), Mr.K.P Srinivasan (Incharge, Mumbai) have extended support to us at all times but they themselves agree that they have no control over their TPA M/s.E-Meditek .Also, they humbly accept that they are fed up of M/s.E-Meditek as much as the policy holders and they have appointed a new TPA to resolve the problem.
However, unfortunately our above mentioned claims are under M/s.E-Meditek and we haven’t received any compensation till date.
We have tried to contact M/s.E-Meditek number of times through Phone, Email etc. but all in vain.
In fact Mr.K.P Srinivasan was kind enough to give us the Mobile number of Dr.Yashendra ([protected]) but the same was never answered.
We look forward for your kind intervention in order to receive compensation against both our above mentioned claims and monetary compensation against the large amount of precious time, money and energy wasted.
Also, We would like to bring to your notice that we are not the only family suffering due to the behaviour of M/s. E-Meditek but there are hundreds of such other cases against this party lodged on various consumer forums on the internet.
=======================================================================
To: <mc.[protected]@nic.co.in>
From: "Aman.M.Tekriwal" <[protected]@gmail.com>
Date: 01/03/2009 07:55PM
Subject: Troublesome claim procedure
Reference:
Claim No: NI/INDV/122008/00170833
Policy number: 250700/48/08/[protected]
Discrepancy Letter No:EMSL/DISC/122008/00238499
Dear Sir,
This letter refers to the claim lodged on 10/12/08 for the expenses incurred towards the Osteoporosis treatment of Mrs.Sumitra Tekriwal.
We have submitted all documents as demanded in the claim form and completed all procedures as per the guide lines of your company.
In spite of doing the tedious documentation, we have received a letter from M/s.E-Meditek Solutions ( Discrepancy Letter No:EMSL/DISC/122008/[protected] asking for the following:
1.)Past policy details with claim status of last 4 years certified by national insurance
2.)Exact Duration of Osteoporosis Certified by treating doctor
We request you to let us know the following:
1.)Is it our duty to arrange the document asked above in point no.1 or the same shall be sought by the third party directly from National Insurance?
2.)What is the significance of the document demanded in point no.2 mentioned above?
What is meant by duration of osteoporosis?Please elaborate.
This sort of troublesome claim procedures, unnecessarily bothering the customer for documents which have no significance reflects upon the in genuine attitude of the third party M/s.E-Meditek Solutions.
We request you to look into this matter on top priority and do the needful for getting the claim processed avoiding any further trouble and waste of precious time, your's as well as ours.
Best Regards
Manoj Tekriwal
Mobile# +91-[protected]
From: MC.[protected]@nic.co.in
To: [protected]@gmail.com
Cc: PM.[protected]@nic.co.in ; SN.[protected]@nic.co.in ; [protected]@nic.co.in
Sent: Monday, January 05, 2009 9:10 PM
Subject: Fw: Troublesome claim procedure

Mr.Tekriwal,

We thankfully acknowledge your mail asking for reasons for demanding certain information by TPA in order to settle your which has been preferred on us.We do not know whether this policy under which claim is lodged is the first policy or renewal of previous one.However the information intended for is to rule out the possibility of pre-existing disease, which is an exclusion. Thus you will appreciate the same is to facilitate settlement of claim.

As regards to information under item no.1 we are also advising policy issuing office to make their efforts for providing desired information to TPA if they are having all the details of previous years policies. While as information under item 2 is to be provided by you only from a treating Doctor.Duration of disease means the time span of it or in more clear terms when the disease Osteoporosis was first detected/ came in notice.

Copy of this mail is also being forwarded to Regional office I Mumbai under whose control policy issuing office is working with a request to extend all possible cooperation to you in this connection.We hope you will listen from them in due coarse of time or else you may contact them at pm.[protected]@nic.co.in (Mrs.P.M.Vaz) or sn.[protected]@nic.co.in(Mr.S.N.Bhalerao, RM).

We valued your time sir.
With Warm Regards

Dr. M C Agarwal
Chief Manager & CPIO
CRM DEPTT.
National Insurance Co.Ltd.
Head Office, 3, Middleton Street
Kolkata 700071
Ph[protected]D)
fax[protected]
Mobile - [protected]
e-mail mc.[protected]@nic.co.in
Wan[protected]
From: "Aman.M.Tekriwal" <[protected]@gmail.com>
To: <MC.[protected]@nic.co.in>
Cc: <PM.[protected]@nic.co.in>; <SN.[protected]@nic.co.in>; <[protected]@nic.co.in>
Sent: Tuesday, January 06, 2009 9:12 PM
Subject: Re: Troublesome claim procedure

Mrs.P.M Vaz,
As per telecon with you we anticipate your prompt response regarding the claim processing of the claim lodged on 10-12-08.Please
give us some time while we give you details of our two more claims which are pending.
Best Regards
Aman.M.Tekriwal

From: Anita.[protected]@nic.co.in
To: Aman.M.Tekriwal ; MC.[protected]@nic.co.in ; PM.[protected]@nic.co.in ; SN.[protected]@nic.co.in ; NC.[protected]@nic.co.in
Cc: KP.[protected]@nic.co.in
Sent: Wednesday, January 07, 2009 11:27 AM
Subject: Manoj Tekriwal - Troublesome claim procedure

We have replies to e-meditek the query raised by them on 6.1.2009


REGARDS,
ANITA YADAV (NAGOTHANEKAR)
ADMN. OFFICER(MISC. DEPT)
(DO VII)/250700
NATIONAL INSURANCE CO. LTD.
104. BHARAT HOUSE, MUMBAI SAMACHAR MARG,
MUMBAI 400 023
TEL NO. 22670419/3692
WAN[protected]


[protected]/MBRO-I/NIC wrote: -----
To: K P Srinivasan/MBRO-I/[protected]@NIC, Anita Nagothanekar/MBRO-I/[protected]@NIC
From: 250700/MBRO-I/NIC
Date: 01/07/2009 11:18AM
Subject: Fw: Re: Troublesome claim procedure
RECD FROM H.O
TKS N RGDS
MOHAN IYER
D.O.7, MUMBAI
-----Forwarded by 250700/MBRO-I/NIC on 01/07/2009 11:16AM -----
To: 250700/MBRO-I/[protected]@NIC, P M Vaz/MBRO-I/[protected]@NIC
From: M C Agarwal/HO/NIC
Date: 01/06/2009 09:38PM
cc: S N Bhalerao/MBRO-I/[protected]@NIC, N C Chowdhury/HO/[protected]@NIC
Subject: Fw: Re: Troublesome claim procedure
Dear Sir,
Please take up the issue with TPA for immediate resolution and also to provide past claim experiance and details of any pre-existing disease as required by TPA.
With Warm Regards

Dr. M C Agarwal
Chief Manager & CPIO
CRM DEPTT.
National Insurance Co.Ltd.
Head Office, 3, Middleton Street
Kolkata 700071
Ph[protected]D)
fax[protected]
Mobile - [protected]
e-mail mc.[protected]@nic.co.in
Wan[protected]

-----Forwarded by M C Agarwal/HO/NIC on 01/06/2009 09:34PM -----
To: <MC.[protected]@nic.co.in>
From: "Aman.M.Tekriwal" <[protected]@gmail.com>
Date: 01/05/2009 10:27PM
cc: <PM.[protected]@nic.co.in>, <SN.[protected]@nic.co.in>, <[protected]@nic.co.in>
Subject: Re: Troublesome claim procedure
Dear Mr.Agarwal,
Thank you for your courtesy and prompt response.As per information required by you,
1.)Policy is a renewal policy and not a new policy
2.)As for duration of osteoporosis, we have spoken to the third party but surprisingly meaning explained by you and the third party is different.Which one do we consider to be correct?
As per your explanation, it means the time span when osteoporosis was detected and as per the third parties explanation, the time span of the treatment.
Another interesting fact is that both of the above requirements are clearly evident from the submitted documents.I hope you will agree that your tpa is doing nothing else but wasting yours, ours and senior Doctors precious time by demanding such insignificant papers.
If these sort of things are not corrected in the prima facie stage, they will continue to make the system inefficient resulting in nothing else but decreased productivity and waste of precious time.
Best Regards
Aman.M.Tekriwal
From: Aman.M.Tekriwal
To: Anita.[protected]@nic.co.in
Sent: Wednesday, January 07, 2009 7:46 PM
Subject: Re: Manoj Tekriwal - Troublesome claim procedure

In how much time will we get the cheque?
From: "Aman.M.Tekriwal" <[protected]@gmail.com>
To: <Anita.[protected]@nic.co.in>
Sent: Saturday, January 10, 2009 11:27 AM
Subject: Re: Manoj Tekriwal - Troublesome claim procedure

Dear Ms.Anita Yadav,
This refers to telecon with you on 10/01/09.We had visited the doctor owing to the pain from which Mrs.Sumitradevi Tekriwal was
suffering since 5-6 days before 24/10/08.On 24/10/08 osteoporosis was detected which is clearly evident from the bone density report
submitted to M/s.E-Meditek.The report clearly states that a T score of less than equal to -2.5 S.D is osteoporosis.
Best Regards
Manoj Tekriwal
To: <Anita.[protected]@nic.co.in>, <MC.[protected]@nic.co.in>, <PM.[protected]@nic.co.in>, <SN.[protected]@nic.co.in>, <NC.[protected]@nic.co.in>
From: "Aman.M.Tekriwal" <[protected]@gmail.com>
Date: 01/12/2009 07:15PM
cc: <KP.[protected]@nic.co.in>
Subject: Re: Manoj Tekriwal - Troublesome claim procedure
We are waiting for your reply.We are in severe need of money.Please send the cheque asap.
Best Regards
Manoj Tekriwal
From: KP.[protected]@nic.co.in
To: [protected]@emeditek.com
Cc: Anita.[protected]@nic.co.in ; MC.[protected]@nic.co.in ; PM.[protected]@nic.co.in ; SN.[protected]@nic.co.in ; NC.[protected]@nic.co.in ; KP.[protected]@nic.co.in ; Aman.M.Tekriwal
Sent: Tuesday, January 13, 2009 3:25 PM
Subject: Manoj Tekriwal - Troublesome claim procedure

Dr Yash,

Kindly release this payment on priority basis, if requirements are complied with.

- regards,
K. Prasanna Srinivasan
Manager,
National Insurance Co Ltd
Mumbai DO[protected]
Phone[protected]
Fax[protected]
email KP.[protected]@nic.co.in
To: <KP.[protected]@nic.co.in>
From: "Dr. Yashendra" <[protected]@emeditek.com>
Date: 01/16/2009 10:04AM
cc: <Anita.[protected]@nic.co.in>, <MC.[protected]@nic.co.in>, <PM.[protected]@nic.co.in>, <SN.[protected]@nic.co.in>, <NC.[protected]@nic.co.in>, "'Aman.M.Tekriwal'" <[protected]@gmail.com>
Subject: RE: Manoj Tekriwal - Troublesome claim procedure
Dear Sir,

The below case is approved and is in float bill no 183.

Regards,
Dr. Yashendra
From: MC.[protected]@nic.co.in
To: [protected]@gmail.com
Sent: Sunday, January 18, 2009 6:08 PM
Subject: Fw: RE: Manoj Tekriwal - Troublesome claim procedure

Mr.Tekriwal,

As aware your claim has been approved and payment would reach to you shortly.Please bear with us.
With Warm Regards

Dr. M C Agarwal
Chief Manager & CPIO
CRM DEPTT.
National Insurance Co.Ltd.
Head Office, 3, Middleton Street
Kolkata 700071
Ph[protected]D)
fax[protected]
Mobile - [protected]
e-mail mc.[protected]@nic.co.in
Wan[protected]










----- Original Message -----
From: PM.[protected]@nic.co.in
To: Aman.M.Tekriwal
Sent: Friday, January 23, 2009 1:14 PM
Subject: Re: Manoj Tekriwal - Troublesome claim procedure

Dear Sir

We are in receipt o[censored]r mail and have taken up the matter with our TPA emeditek and they have conformed that it has been approved and is placed under float bill no.183 u may get ur cheque after 10 -15 days.





Prescilla M Vaz
A.O. (CSD)
MBRO-I
e-mail: PM.[protected]@nic.co.in
From: "Aman.M.Tekriwal" <[protected]@gmail.com>
To: <PM.[protected]@nic.co.in>
Sent: Friday, January 23, 2009 3:56 PM
Subject: Re: Manoj Tekriwal - Troublesome claim procedure
Page 1 of 1
2/7/2009
Dear Madam,
Greetings of the day ! After approval why does it take 10-15 days to send the cheque.FYI private companies like reliance are able to successfully close the entire case after submitting the claim within 10 working days maximum(including receipt of cheque).
Best Regards
Manoj Tekriwal
From: "Aman.M.Tekriwal" <[protected]@gmail.com>
To: "Dr. Yashendra" <[protected]@emeditek.com>; <KP.[protected]@nic.co.in>
Cc: <Anita.[protected]@nic.co.in>; <MC.[protected]@nic.co.in>; <PM.[protected]@nic.co.in>; <SN.[protected]@nic.co.in>;
<NC.[protected]@nic.co.in>
Sent: Sunday, January 25, 2009 2:46 PM
Subject: Re: Manoj Tekriwal - Troublesome claim procedure

Dear Sirs/Madam,
Following are the details of our one more past claim which is pending, we believe that with your efficient intervention the same can be resolved.
Claim No. : NI/INDV/32007/00139868
Policy number: 250700/48/06/[protected]
Anticipating your prompt response
Best Regards
Manoj Tekriwal





From: "Aman.M.Tekriwal" <[protected]@gmail.com>
To: <Anita.[protected]@nic.co.in>
Sent: Tuesday, January 27, 2009 1:55 PM
Subject: Re: RE: Manoj Tekriwal - Troublesome claim procedure
Payment for claim approved(Float bill no.183) not received till date.More than 1.5 months have passed after filing the claim.Is this your normal processing time?

Best Regards
Manoj Tekriwal
From: "Aman.M.Tekriwal" <[protected]@gmail.com>
To: <MC.[protected]@nic.co.in>
Cc: <Anita.[protected]@nic.co.in>
Sent: Wednesday, January 28, 2009 7:49 PM
Subject: Fw: RE: Manoj Tekriwal - Troublesome claim procedure
Dear Sir,
We request you to please release our payment as we have mentioned earlier about we being in need of money.You will appreciate our patience i.e 48 days have already passed by after the claim was received by TPA.I hope you understand our situation, we have already given detail about one more past pending claim to Ms.Anita.Total amount due approximately > 50000.How can middle class people wait for so long for expenses they have already incurred plus premiums which are paid every annum.Poor people will gradually start loosing faith in insurance.Have we ever delayed payment of premium by a single day? Why this kind of treatment with us?
Best Regards
Manoj Tekriwal
From: KP.[protected]@nic.co.in
To: Dr. Yashendra
Cc: 'Aman.M.Tekriwal' ; SC.[protected]@nic.co.in ; Anita.[protected]@nic.co.in ; MC.[protected]@nic.co.in
Sent: Thursday, January 29, 2009 11:33 AM
Subject: Mediclaim - Sri Manoj Tekriwal

Dear Dr Yash,
Considering the financial difficulties faced by the claimant ( pl see the appended mail ), we would request you to make arrangement to kindly release this payment on priority basis from the next float payment and not to wait untill float no 183.
- regards,
K. Prasanna Srinivasan
Manager, National Insurance Co Ltd Mumbai DO[protected]
Phone[protected]
Fax[protected]
email KP.[protected]@nic.co.in



From: "Aman Tekriwal" <[protected]@gmail.com>
To: <MC.[protected]@nic.co.in>
Cc: <KP.[protected]@nic.co.in>
Sent: Sunday, February 01, 2009 10:29 AM
Subject: Re:Mediclaim-Shri Manoj Tekriwal

Dear Dr.MC Agarwal,
Please refer to the appended email.In spite of clear instructions from senior officials like Mr.K.Prasanna Srinivasan from your
company, TPA E-Meditek does not respond.The fact that they have a habit of harassing customers by demanding unnecessary
documents was already known but now it seems they have a similar attitude towards the insurance company.
Also Ms.Anita Nagothanekar(Yadav) at your Mumbai branch is not at all bothered to respond to the customer.I have given her
details of my past pending claim(other than the one in discussion) as mentioned below
Claim No. : NI/INDV/32007/00139868
Policy number: 250700/48/06/[protected] but she never bothered to reply.
I am sorry to mention but private companies like ICICI lombard, Reliance general are able to dispatch the cheque within 2 weeks of
claim submission, they have cashless tie-ups with the best of the hospitals, and their staff is highly customer responsive.
However I shall appreciate once again, the prompt response and customer responsive attitude reflected from your way of
working as an individual, but I am sorry to say that the same is no where visible in your staff.
Best Regards
Manoj Tekriwal
From: MC.[protected]@nic.co.in
To: [protected]@gmail.com
Sent: Sunday, February 01, 2009 9:57 PM
Subject: Re:Mediclaim-Shri Manoj Tekriwal

Dear Mr.Tekriwal,

We have already taken up the matter of releasing of your claim cheque with our RO as well as TPA.Once claim is approved payment would be released soon, there is matter of time but without any scope of any sort of harassment, whatsoever.Please bear with us.
With Warm Regards

Dr. M C Agarwal
Chief Manager & CPIO
CRM DEPTT.
National Insurance Co.Ltd.
Head Office, 3, Middleton Street
Kolkata 700071
Ph[protected]D)
fax[protected]
Mobile - [protected]
e-mail mc.[protected]@nic.co.in
Wan[protected]






From: "Aman.M.Tekriwal" <[protected]@gmail.com>
To: <KP.[protected]@nic.co.in>
Cc: <MC.[protected]@nic.co.in>
Sent: Friday, February 06, 2009 5:59 PM
Subject: Claim
Reference:
Claim#
1.) NI/INDV/32007/00139868
2.) NI/INDV/122008/00170833
Dear Mr.Srinivasan,
Greetings of the day !After exchanging 15-20 emails, It was a pleasure talking to you on 06/02/2008.
The conclusions I have derived out of the conversation are as follows:
1.)The payment against the claim which is to be funded by National Insurance is at TPA's discretion.
2.)Ours is not the only case, but there are a large number of people who are facing problems with M/s.EMeditek
3.)National Insurance has decided to go for a new TPA for the new and the renewed policies.
We strongly believe that every penny paid by us to National Insurance as premium was hard earned and all the claims
requested by us till date were/are very genuine.Also we are confident that honesty is an integral part of New
India's organizational culture.
But, the fact remains that TPA M/s.E-Meditek is taking us all for a ride.We thank you for giving us contact
details of M/s.E-meditek, but as informed by you well in advance, they do not respond to telephone
calls/emails.
A lot of time, money, energy has already been wasted at both ends.Also, while purchasing the policy, we had
taken into consideration National Insurances reputation and not E-Meditek.In order to close this asap we propose the
following:
1.) National Insurance to directly pay us for both our pending claims over ruling all inefficient
procedures, documentation within 7 working days.
2.)If required National Insurance can do an in-house reassessment of the claim to confirm genuinity.
3.)We shall refund immediately any double payment if received from E-Meditek
Please take your time and let us know your decision within a working day.Incase we do not receive your
response, we will be forced to take up the matter with Mr.Vashisht(Insurance ombudsman) for Maharashtra.
Best Regards
Manoj Tekriwal