[Resolved]  United India Insurance Co. Ltd — WRONG SETTLEMENT OF MATERNITY BENEFITS

Address:

Mumbai Suburban, Maharashtra

I MR VISHVANATH B KOLI PH. NO [protected] HAD TAKEN A FLOATER ( FAMILY ) MEDICLAIM POLICY FROM CANARA BANK WHICH WAS ISSUED BY UNITED INDIA INSURANCE CO LTD.
I PAID THE REGULAR PREMIUMS FOR 4 YEARS REGULARLY ON 4TH NOV MY WIFE WAS OPERATED FOR MATERNITY ( CAESAREAN) I SUBMITTED THE CLAIM ON 11TH NOV AND AFTER A CONTINOUS FOLLOWUP FOR 65-70 DAYS THE TPA HAD PREPARE A CHEQUE OF 32000 ODD AMOUNT BUT DID NOT DISPATCH STATING THAT THERE WAS AN ENQUIRE FROM UNITED INDIA . CO LTD., ON ENQUIRING WITH UNITED INDIA I WAS TOLD THAT I WILL BE ELEGIBLE ONLY FOR 5 % OF SUM ASSURED WHICH IS ONLY 5000/- BUT THE CONTRACT CLEARLY STATE AS FOLLOWS.

CLAUSE E.
MATERNITY BENEFIT AND BABY CARE :
A. MATERNITY EXPENSES BENEFITS : MEANS TREATMENT TAKEN HOSPITAL / NURSING HOME ARISING FROM A TRACEABLE TO PREGNANCY, CHILD BIRTH INCLUDING NORMAL CAESAREAN SECTION. WAITING PERIOD IS 9 MONTHS

B. BABAY CARE MEANS , EXPENSES RELATING TO TREATMENT GIVEN TO THE NEW BORN CHILD IN HOSPITAL AS AN INPATIENT FOR A MAXIMUM PERIOD OF 90 DAYS FROM THE DATE OF ITS BIRTH . THE REIMBURSEMENT IN BABY CARE WILL BE LIMITED TO THE ACTUAL EXPENSES SUBJECT TO A MAXIMUM OF 5 % OF SUM INSURED OPTED IN MEDICLAIM SECTION . AFTER 90 DAYS FROM THE DATE OF BIRTH, YHE BABY WILL HAVE TO BE COVERED UNDER POLICY ON PAYMENT OF ADDITIONAL PREMIUM

FROM ABOVE 2 CLAUSE IT IS UNDERSTANDABLE THAT THE, THE BABY CARE IS MAX 5% FOR WHICH I HAVE NOT CLAIMED ANY THING , I HAVE MADE A CLAIM ONLY FOR MATERNITY BENEFIT
PLEASE HELP