[Resolved]  United India Insurance Co. Ltd., Chennai — Non acceptance of my appeal to allow me For CASHLESS BENEFIT / REIMBURSABLE TREATMENT against my Mediclaim Policy

from :- Address :-
Pranab Kumar Dey (Cancer Patient) 2/2, Dr. J.R. Dhar Rd.,
email : [protected]@yahoo.com Dum Dum, Kolkata - 700 028
[protected]@yahoo.co.in (Mob : [protected])

To
The Manager,
Grievance Department,
United India Insurance Co. Ltd.
8th Floor, Kanchanjunga Building,
17, Barakhamba Road,
New Delhi - 110001



Dear Sir,

I, Pranab Kumar Dey, residing at 2/2, Dr. Jiban Ratan Dhar Road, Kolkata, India, Pin – 700 028, purchased a Mediclaim Policy from United India Insurance Co. Ltd. Vide no. 010500/2009/[protected]/1, on Sept.'2005 (AROGYA RAKSHA POLICY, which is jointly organized by Indian Bank & United India Insurance Co. Ltd.). My TPA is M/s. TTK HEALTH CARE SERVICES PVT. LTD. vide card no. CHE-UI-IN[protected]A, has also been issued to me consecutively since last 2005 embossing my photo.

I have been suffering from Cancer since last few years and underwent two major surgeries once in the year 2004 & another in the year 2008. Since the insertion of my Mediclaim Policy (Sept. 2005) I have never claimed any amount from them.

Sir, on 21.12.2009 morning, I took admission in AMRI Hospital – Dhakuria, P-4 & 5, CIT Scheme –LXXII, Block – A, Gariahat Road, (Beside Dhakuria Bridge), Kolkata – 700029 for taking Chemotherapy as per the advice of Renowned Dr. G.S. Bhattacharya, MD, In-charge of Haemato Oncology.

Before taking admission in this Hospital I submitted the necessary Mediclaim form, duly filled-up by me along with other relevant documents for availing the Cashless benefit through the proper channel/as per the rules of this Hospital.

But, I very much regret to mention that inspite of being a “Claim Free” policy holder since last 2005, both TTK & United India Insurance Co. Ltd. have out-rightly
Rejected my application, mentioning “It is a Pre-Existing Disease”, irrespective of having the Circular issued by the Insurance Regulatory and Development Authority (Irda) in June, 2008 to all the Mediclaim Agencies where it has been very clearly mentioned that all Pre-Existing Disease will henceforth be covered provided 48 months of continuous coverage has elapsed, since inception of the first policy with concerned Mediclaim Insurance Company.

A verdict on “PRE-EXISTING DISEASES” published by a bench of Justices Mr. S. B. Sinha and Mr. V. S. Sirpurkar of our Hon’ble Supreme Court was also enclosed for their ready reference.

Later after submission of above circular & documents, in a reply from TTK, one officials named Ms. Swarna has clearly mentioned that after completion of 3 (non claimed) years we are eligible to avail Cashless or Reimbursable Treatment in case of any Pre-existing diseases.


But, at the same time surprisingly she rejected my claim mentioning that during the time of Renewal in the year 2008-09 there was a gap of 17 days, for which they have rejected my claim. This was the second time excuse for not accepting my claim. The reason for 2nd time rejection is totally baseless & untrue. Because I am in the habit of submitting all my Renewal Premium in time. In support of my timely submission of Renewal Premium, I have attached all my documents and mainly one notice mentioning the Renewal date for my policy, which was jointly issued by Indian Bank & United India Insurance Co. Ltd. vide letter Ref. No. HO/BASC/642/2008-09 dated 05.08.2009.

Sir, I have been admitted in another Nursing Home (ORCHID NURSING HOME, PHULBAGAN, KOLKATA) for taking 2nd cycle Chemotherapy under the guidance of Dr. G.S. Bhattacharya. (out of 6 cycle chemotherapy, this is the 2nd cycle, rest 4 cycle to be taken later on).

Sir, during these days I have again submitted my appeal to allow me to avail the CASHLESS BENEFIT OR REIMBURSABLE TREATMENT through various emails, copy marked to various Officials/ Departments (if required then I can submit all my correspondences along with the enclosures). This time another Official from Chennai Office named Ms. Amina has contacted me as well as my younger brother. As I have been admitted for 2nd cycle Chemotherapy, so my brother Mr. Prasun Kumar Dey contacted her and informed briefly the matter. Ms. Amina said that she would let us know the outcome within a very short time.

I repeatedly requested her that time is too short and we are running penny less so we are eagerly waiting for a positive & quick response from them. But, surprisingly no response has reached us so far.

Sir, inspite of a genuine, non-claimed policy holder for last 4 years, already I have lost thousands of rupees for not accepting my appeal. I have completed three days in this Nursing Home. And till date no response has come either from TTK or from United India Insurance Co. Ltd.

Both TTk & United India Insurance Co. Ltd., Chennai are jointly harassing me by highlighting/mentioning some FALSE/BASELESS & UNTRUE excuses which is not acceptable at all. (as I am in the nursing home, hence my younger brother is writing this letter in favour of me).

Kindly help me out & save my life.

With regards,
Prasun Kr. Dey (Mobile : +91 [protected], email id : [protected]@yahoo.co.in)
(brother of Mr. Pranab Kumar Dey, Patient)


For Pranab Kumar Dey (Mob : [protected]) email id : [protected]@yahoo.com
(Patient) Age : 47+, Admitted on 12.01.2010 at ORCHID NURSHIN HOME, PHULBAGAN, KOLKATA
TTK ID Card No. CHE-UI-IN[protected]A
Pre Authorisation No. CHE-1209-PA-0002517
Policy No. “ 010500/2009/[protected]/1


Copy to: United India Insurance Co. Ltd., Chennai Office
Copy to : MR. T.T.JAGANNATHAN, Director
Copy to : MR. K.SHANKARAN, Director
TTK Heralthcare Srvices Ltd.


Copy to : Dr J S L PRASAD
CHIEF MANAGER
GRIEVANCE DEPARTMENT
HEAD OFFICE
CHENNAI.