[Resolved] Royal Sundaram Health Shield Policy — Rejection of Cashless Facility | |
Dear Sir, I am Mallari Rao M.S. taken Health Shield Policy for self, my wife and my son from Royal Sundaram Alliance Insurance Company Ltd in December 2005 and being renewed the policy every year. My health shield policy was renewed on 28 December 2009 by paying renewal of Rs.3,363/- and the same has been confirmed by the insurance comapny. My wife was admitted to hospital on 12 th January 2010 due to high viral fever. When the hopital authorities sent the cashless treatment request to Royal Sundaram Alliance Insurance TPA M/s Medicare TPA Services (I) Private Ltd for sanction, the TPA had declined the claim stating the reason as the Policy remains lapsed on 28/12/2009.. Cashless not admissible. I had contacted both Royal Sundaram Alliance Insurance Company regarding this, the officials informed that they have already sent a email to TPA confirming the renewal. However the TPA did not send the cashless treament approval till the discharge of my wife from the hospital. She was discharged from the hospital on 15/1/2010 and I have paid the bill to Hospital Authorities. Please let us know whether I can file case in Consumer Forum. Was this information helpful? | |
Aug 14, 2020 Complaint marked as Resolved | |
 1 Comment | |
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+91 44 7117 7117 [Corp Office]
Vishranthi Melaram Towers, No.2/319, Rajiv Gandhi Salai (OMR), Karapakkam, -, Chennai, Tamil Nadu, India - 600097
Lodge a complaint with the Insurance Ombudsman in Chennai ( where Royal Sundaram has its HO) or the Insurance Ombudsman who has jurisdiction in your area of residence., You will get the address of all Insurance Ombudsman from the IRDA site. www.irda.gov.in
Please give full details of your Policy, its last renewal and attach the rejection of your claim letter received from Royal Sundaam along with your complaint to Insurance Ombudsman.
The service of Insurance Ombudsman is free, no fees, nor is the need for any lawyer to file the complaint. You can draft the complaint yourself and send it by Speed Post or Regd. Post to the Insurance Ombudsman.
In this case, since there is negligence on the part of Royal Sundaram as well as their TPA in rejecting your cashless facility you can also claim damages due to mental anguish and financial loss suffered by their wrongful actions. Insurance Ombudsman is an independent authority having authority to investigate in to complaints from individual insurance policy holders . Their award is binding on all Insurance Companies, whether in Public Sector or Private Sector.
Premraj.C
premraj.[protected]@gmail.com