[Resolved]  Universal Sompo General Insurance Co. Ltd — Regarding Cashless treatment for declared pre existing disease

Address:

Chandigarh, Chandigarh

Universal Sompo General Insurance Co Ltd
Express IT park , Plot No EL-94, T.T.C.
Industrial Area M.I.D.C. Mashape,
Navi Mumbai -400710


Sir,
I had purchased a IOB Health care policy in march 2007, and declared my pre existing disease since 1992.I was allotted a policy no 2007/[protected]/59 (united India insurance company) . The terms and conditions of the policy regarding exclusions read as follows
“1.All disease / injury which are pre existing when cover incepts for the first time. This exclusion will be deleted after three consecutive continuous policy years provided there was no hospitalization for the pre - existing aliment during these three years of insurance. For the purpose of applying this condition, the date of inception of the initial medical policy taken from any of the Indian insurance Company shall be taken provided the renewals have been continuous and without any break.
After taking the first policy I have been paying my premiums on a regular basis without any break. The policy no details have been mentioned below
2817/50086834/01/B0 March 2011 to March 2012
2817/50530614/00/000 March 2010 to March 2011
2817/5008634/00/000 March 2009 to March 2010
2008/[protected]/16 March 2008 to March 2009
2007/[protected]/59 Initial enrollment period 26 March 2007 to 25 march 2008.
Sir I had applied for the replacement of AICD through your TTK Network hospital “ Fortis Mohali “ on cash less basis, initially there was some objection regards hospital form etc which were duly amended by the hospital authorities and submitted subsequently the hospital was informed that the member has not yet completed 3 continuous years premiums ,and is not eligible for treatment.
I started checking for my records etc and found that every thing was in order. The issue was discussed in detail with Mr Sunil At your Chandigarh Office ( Swastik Vihar )
Here I clarified that I had cleared the necessary condition to be eligible for treatment from your company , all necessary documents were shown, and asked for the reason for denial of the treatment as per rules laid down in your policy Mr Sunil Kumar was indeed very very helpful in contacting his higher authorities . After a few days I was told that I was not eligible for cashless treatment for reason best known to your companie’s employees.

.. 2..
I would like to stress here that why does a person after paying regular premiums to your company is not eligible to avail the facilities for which the policy was taken. I think your company is also like any other fraud company employing marketing staff just to sell policies & collect premiums to complete your targets to shown a northward graph of the company’s growth.
I request you to kindly reply to my mail with reasons for refusing cashless treatment to me so that I may look forward for a medically secure future.
Sincerely your’s

Sukhjit Singh
[protected]
# 1724, Sector -33D
Chandigarh
Dated 3rd December 2011