[Resolved]  National Insurance/family Health Plan (Fhpl), Karvy Finance Broking — Maternity Claim rejected based on the clause of 9 month waiting period which is nowhere mentioned in the policy documents

Address:

Thane, Maharashtra

I have taken up the Karvy group mediclaim policy provided by the National Insurance Company where the third party administraor is Family Health Plan Ltd(FHPL) and Karvy is the broker. This group mediclaim poicy can be taken up by all the customers of the Karvy.

The current year policy details are
Policy no: 154400/46/[protected]
UHID No: NIC.[protected].
Plan period: 13/01/2011 to 12/01/2012


My Wife was admitted for the maternity hospitalization on 15th AUgust, 2011.
Details:
Name: Vrushali Hrishikesh Dabhade
Date of Admission: 15/08/2011
Date of Discharge: 20/08/2011
Hospital name: Kamat Hospital
Claim Amount approx Rs 40,000/-

After I submitted all the required papers, I was told by the FHPL customer care executive that the claim has been rejected as there is waiting period of nine month for claiming the maternity expense benefit under the policy. The policy document provided to me by the Karvy (Mr Promod an employee of Karvy who has left Karvy now) and also present on the website does not mention any such clause/condition of waiting period of nine month nor I was inform of any such clause. More over this is my second year of the policy, in that terms as well I have satisfied the said clause of nine months waiting period. My last year policy details are

Last year Policy No: 154400/46/09/[protected]
UHID No: FHKN.[protected]
Plan period:30/11/2009 to 29/11/1010

I am told, only after the claim was rejected, that my policy was not renewed but I was issued a new policy being there a gap between the current and last year policy . I had tried to get the policy renewed much before expiry and had word with Mr Pramod (cell:[protected]) from Karvy (he has left Karvy now and he is the person who sent me those policy document that supressed the 9 month clause, this 9 month waiting clause is also not mentioned on fhpl site which is another source of policy terms and conditions for the subscriber), and he was to send a office boy/delivery boy to get the document collected which never happened. Finally I sent the document (with policy renewal form and not the new policy form- I was assured it will be renewed policy and not the new policy) by courier and it reached the Karvy by 14/12/2010. Even after this the new policy was issued to me starting 13/01/2011 and the mediclaim card reached to me only in the 2nd week of February.
I have been talking/writing mails with Many people like Susan Orwin, Karvy employee-Hyderabad office(+[protected], cell no: +91 [protected], susan.[protected]@karvy.com), FHPL([protected]) - Saikat Karmakar, Sanjith , Kolkatta office[protected], goutam.[protected]@nic.co.in[protected], [protected]@fhpl.net. FHPL as a Third party settlement administrator has rejected the claim on the ground of clause in the policy which was never shared with me by Karvy.
I believe Karvy had purposefully removed such clause from the document that they had used to sell the policy.
Susan who is looking after this business after Pramod from Karvy is aware of the complete cases since long time and it’s the complete fraud case on part of Karvy official where I had not been given the complete information on the policy terms and condition. The document provided to me did not mentioned of the waiting period of 9 months for the maternity benefit claim which is complete slippage on part of Karvy which she is aware of. And as per my discussion with Susan she had acknowledge this fact and Karvy as an organization is fearful for being on the wrong side for this loss of claim due to rejection.
Now Susan is refusing to take the responsibility as the person who has done the damage is no more with the Karvy, So Karvy as an organization should take the responsibility for the mis deed of its ex-employee and make good for the claim amount of Rs. 40,000/-.

Goutam Ghosh from NIC has now commited to take a look in this case as he is aware of the fact that there is something wrong from the NIC/FHPL/karvy & he had commited to take a decision by Monday,14th November 2011.
Also it is causing me lot of pains, mental stress and efforts (even after paying the Policy premium of Rs 16,000+ approx) to follow up on the case with hundreds of phone calls, writing at least 10-15 mails and repeated explanation of the case to different people. I solicit the compensatation for the same along with the medical expense claim amount.

Also I have not been issued the original receipt issue by NIC untill date for the full premium paid, I doubt Karvy has paid full amount to the NIC as a premium that was taken from its customers.

Thank you,

Regards,
Hrishikesh.