[Resolved]  HDFC Bank ERGO General Insurance Company Limited — Rejection of Cashless Claim Facility for Mrs Subhra Dutta at AMRI Hospitals, Kolkata

Address:

Kolkata, West Bengal

I, Dr Balai Chandra Dutta, had Mediclaim Policy with M/s National Insurance Company since 01/08/2004 for myself, my wife Mrs Subhra Dutta & my son Sri Sayantan Dutta. I continued with the company and went on renewing our policy till 31/07/2012 uninterruptedly. Under the Policy portability facility I transferred our Policy from M/s National Insurance Company to M/s HDFC ERGO General Insurance Company with effect from 01/08/2012 and renewed on 01/08/2013, by which our policy is valid till 31/07/2014. I even received the the No Claim bonus accumulated with former Insurer as CB Amount. As on date Sum Insured for each one o[censored]s are Rs 3.00 Lakhs and bonus are Rs 91000/ for me, 51000/ each for my wife & son. Very recently my wife was suffering from Gynecological problem with Fibroid Uterus & Endometritis as diagnosed by the doctors who advised Surgical Intervention. Accordingly I applied with HDFC ERGO general Insurance Co Ltd on 13/01/2014 and got the Registration No CCN RC-HS[protected] for Cashless Hospitalization benefits for admission to AMRI Hospitals, Salt Lake, Kolkata. But after 4 hours of that I got another sms indicating rejection of Cashless benefits. I have collected copy of the Letters sent by the Insurer to AMRI Hospitals which is added here. I have been compelled to arrange the Admission on 17th as planned & Operation on 18th Jan'14. Today I released my wife from the hospital & taken back to home. My Total Expenses during these 5 days is Rs 82641/ (Rupees Eighty two thousand six hundred forty one only) which I paid through my Credit Card. Now the issue is - there is nothing mentioned in my policy that I shall be loosing the Medical benefits (with age of policy) after Portability from National Insurance to HDFC ERGO. For a new policy the ref clause no 6.c is applicable but a transferred policy of 8 years + 1.5 years, they just can not deny my claim of Cashless Hospitalization benefits. The HDFC ERGO General Insurance Co Ltd must reimburse all my expenses immediately.