Max Bupa — Rejection of mediclaim and cancellation of policy.

Address:

New Delhi, Delhi, 110044

Policy no. [protected]. Policy commencement date : 21/Jan/2015 till 20/Jan/2016 Policy Name : Family first silver 5lacs + 15 lacs I would also like to tell that : 1. The application form was filled by the agent. 2. As per agent Medical issues to be told to the doctor. 3. Medicals were carried out at residence by a normal person and not by doctor. He could not understand anything. He only knows to make the medical test. 4. Thalassemia minor was reported but there is no note of it. Incident: My father was hospital on 03/July/2015 due chest pain and was advised angioplasty after angiography. Discharged on 05/July/2015. After filing the claim form underwriter sent a doctor for verification. He asked us to show all the old medical reports and papers. He took some papers photocopy and told us it will help in claim process. Following are the conversation between me and maxbupa team. Grievance Redressal To: [protected]@yahoo.co.in Oct 30 at 2:30 PM Dear Sir, Greetings from Max Bupa Health Insurance! This is with reference to your e-mail appended below. We request you to please refer to the definition 14 and clause 3 of the policy Terms and Conditions reproduced below for your ready reference: Def 14: Disclosure to Information Norm: The Policy shall be void and all premium paid herein shall be forfeited to the Company, in the event of misrepresentation, mis-description or non-disclosure of any material facts. Clause 3: Cancellation by us: Without prejudice to the above, We may terminate this policy during the Policy Period by sending 30 days prior written notice to your Address shown in the Schedule of Insurance Certificate without refund of Premium if: · You or any Insured Person or any person acting on behalf of either has acted in a dishonest or fraudulent manner under or in relation to this Policy; and/or · You or any Insured Person has not disclosed the material facts or misrepresented in relation to the Policy; and/or · You or any Insured Persons has not co-operated with Us. Should you require any further assistance, we request you to call us on our Toll Free number[protected] or write to us at [protected]@maxbupa.com/geetanjali.[protected]@maxbupa.com . Yours sincerely, Geetanjali Sapkota Executive- Grievance Redressal Max Bupa Health Insurance Company Limited, B-1/I-2, Mohan Cooperative Industrial Estate Mathura Road, New Delhi-110044 [protected][protected][protected][protected][protected][protected]------- From: jeetu dhawde [mailto:[protected]@yahoo.co.in] Sent: Wednesday, October 28, 2015 9:36 PM To: Grievance Redressal Subject: Re: Max Bupa | Service Request 416489 ||[protected] good day... I understand that u have decided to cancel my policy as per underwriters guidelines. therefore I request to refund my premium. Jeetendra Dhawde On Thursday, 15 October 2015 12:07 PM, Grievance Redressal wrote: Dear Sir, At the outset, we regret that the services at Max Bupa have not been to your satisfaction. We value your feedback as we work relentlessly towards constant improvement of services and customer satisfaction. This is with reference to our email appended below. We would like to inform you that we have got your case reviewed by our panel of doctors and it has been observed that the patient is a known case of Lt ear CSOM on treatment and anemia since 2013 along with for cirrhosis liver, portal Hypertension, anemia and thalassemia minor prior to 7/5/2014 ( History of chronic alcoholism). This has been noted from the documents received from the hospital. We have noticed that the mentioned conditions were not disclosed to us at the time of taking the policy. Further, basis the non disclosures of the material facts, we have decided to cancel the policy as per our underwriting guidelines. Should you require any further assistance, we request you to call us on our Toll Free number[protected] or write to us at [protected]@maxbupa.com/geetanjali.[protected]@maxbupa.com. Yours sincerely, Geetanjali Sapkota Executive- Grievance Redressal Max Bupa Health Insurance Company Limited, B-1/I-2, Mohan Cooperative Industrial Estate Mathura Road, New Delhi-110044 [protected][protected][protected][protected][protected][protected][protected] From: Grievance Redressal Sent: Thursday, October 08, 2015 3:13 PM To: [protected]@yahoo.co.in Subject: Max Bupa | Service Request 416489 ||[protected] Importance: High Dear Sir, At the outset, we regret that the services at Max Bupa have not been to your satisfaction. We value your feedback as we work relentlessly towards constant improvement of services and customer satisfaction. This is with reference to your email appended below. We would like to inform you that we are working on your case and we request you to please give us 7 days for us to share our decision. Your Service request number is 485312. Should you require any further assistance, we request you to call us on our Toll Free number[protected] or write to us at [protected]@maxbupa.com/geetanjali.[protected]@maxbupa.com. Yours sincerely, Geetanjali Sapkota Executive- Grievance Redressal Max Bupa Health Insurance Company Limited, B-1/I-2, Mohan Cooperative Industrial Estate Mathura Road, New Delhi-110044 [protected][protected][protected][protected][protected][protected][protected] From: jeetu dhawde [mailto:[protected]@yahoo.co.in] Sent: Thursday, October 01, 2015 8:32 PM To: Customer Care Subject: Re: Max Bupa | Service Request 416489 ||[protected] good day all, pls note 1. My father was not suffering from hypertension and was never taking any medicine for the hypertension. 2. Prior taking policy from maxbupa the medicals were carried by maxbupa representative. 3. Medical policy was approved by maxbupa after medicals were cleared. 4. My father was hospitalised around in month of May- 2014 but no medicines were continued after that as not prescribed by doctors. 5. Left ear was treated as infected while swimming...it was in 2013. 6. Anaemia(it's hereditary and hence can never be cured) was reported to medical representative who came to conduct the medicals of my father. This was also reported to agent. therefore pls consider my claims and do the needful asap thanku. Jeetendra Dhawde [protected] [protected][protected][protected][protected][protected][protected][protected] On Wednesday, 2 September 2015 12:37 PM, Customer Care wrote: Dear Mr. Dhawde, Kindly ignore the previous email. Thank you for your email dated 26th August 2015 regarding Policy number [protected]. With reference to the mail below, we would like to inform you that during processing of your claim request, we have detected the following medical conditions which were not disclosed to us at proposal stage i.e. at the time of applying for policy number [protected]. 1) Since 2013 insured is a Known case of, Lt earChronic suppurative otitis media on treatment and anaemia. 2) On treatment for cirrhosis liver, anaemia and thalassemia minor as per prescription dated 7/5/2014 ( H/o chronic alcoholism ) 3) Admitted for obstructive airway disease between 17/5/2014 to 21/5/2015 with cirrhosis liver, anaemia and thalassemia minor It is our endeavour to be fair and equitable with all our customers and this commitment can only be honoured if our customers ensure that they disclose their medical condition in the proposal form submitted to us. We regret to inform you that we would have to cancel the policy number [protected] as it would have impacted our underwriting decision at the time of proposal and we are unable to refund the premium. We request you to please refer to the definition 14 and clause 3 of the policy Terms and Conditions reproduced below for your ready reference: Def 14: Disclosure to Information Norm: The Policy shall be void and all premium paid herein shall be forfeited to the Company, in the event of misrepresentation, mis-description or non-disclosure of any material facts. Clause 3: Cancellation by us: Without prejudice to the above, We may terminate this policy during the Policy Period by sending 30 days prior written notice to your Address shown in the Schedule of Insurance Certificate without refund of Premium if: I. You or any Insured Person or any person acting on behalf of either has acted in a dishonest or fraudulent manner under or in relation to this Policy; and/or II. You or any Insured Person has not disclosed the material facts or misrepresented in relation to the Policy; and/or III. You or any Insured Persons has not co-operated with Us. For avoidance of doubt, it is clarified that no claims shall be admitted and/or paid by Us during the Notice Period. We request you to please provide us with valid justification letter along with supporting document in case you want us to review the cancellation induced by company within 30 days of receipt of the email at [protected]@maxbupa.com from registered email ID. In case you need further assistance, please do call us on our toll free number[protected] or write to us at [protected]@maxbupa.com. We will do our best to help you. Yours Sincerely, Customer Services Team Max Bupa Health Insurance Company Limited, B-1/I-2, Mohan Cooperative Industrial Estate Mathura Road, New Delhi-110044 [protected] Original Message[protected] From: JEETENDRA DHAWDE Received: 26/Aug/15 11:14 AM To: ; ; Customer Care Subject: POLICY NO.[protected] Dear all, As my claim no. 143788 is denied, kindly advice me the further steps to be taken by me, to avoid reoccurrence of denial. Let me also express the reason given of denial is a simple excuse from your side. This claim denial had disappointed me. policy holder Jeetendra Dhawde