Ministry Of Finance Govt. Of India — Insurance Co, has wrongly deducted claim amount for COVID 19 case

Address:

The New India Assurance Co. Ltd., Divisional Branch, Trident Complex, Nr. NatubhaiCircle, Gotri, Vadodara

I have taken Health Insurance policy vide no. 221500/34/20/95/00000390 for my parents with The New India Assurance Company Limited since more than 15 years. This is the first time that we have claimed with The New India Assurance Company Limited of my father due hospitalization due to COVID 19 which claim amount is Rs. 83, 263/-.

I would like to brief you my problems as per below:

On dtd. 11th August 2020, my father was hospitalized due to COVID 19 and on 15th August 2020, he has been discharged from hospital and advise for home isolation for next 1-2 weeks. After completing necessary formalities, I have submitted all relevant documents for duly signed & stamped to MD India Health Insurance TPA Pvt Ltd. on dtd. 05th September 2020 which is authorized office of The New India Assurance Company Ltd. My father’s total claim amount is Rs. 83, 263/- out of which MD India has passed only Rs. 49, 786/- and deducted Rs. 33, 477/-. This claim amount was received to us after 2 months after vegerous follow up with MD India.

Since 21st October 2020, we are continuously sent mail to MD India to provide us details working calculation break up of claim passed amount and claim deducted amount but till date we have not received required details with MD India. Even we have called their customer care no too but there also we are not getting satisfaction response. While asking to provide us authorized person name and contact no., they were not provide their details. Till today, we have already sent 8 reminders mail alongwith regular mails to MD India, they are not listening to us. As we have not getting any details from MD India, I have sent mail to The New India Assurance Co. Ltd but they are also not responding to our mail.

Request you to pl see all below trail mail which were sent to MD India as well as The New India Assurance Co. Ltd. for your kind study purpose and for ref. pl.

After so many complaints, finally Insurance Co. has passed Rs. 10760/- & Rs. 6544/- passed and still Rs. 10, 553/- is pending. Since sending 11 reminders still Insurance Co. is not showing any interest to clear my pending claim for Rs. 10, 553/-. We have personally visited to The New India Insurance CO. Ltd. and convey them following.

Total Hospital Room charges & Nursing Charges is Rs. 3500/- per day (Rs. 2500 as Room Charges + Rs. 1000 as Nursing Charges). While considering proportionately it would comes 60.67% (Rs. 12000 *100 / Rs. 19780 = 60.67%) hence accordingly Actual Room + Nursing Charges should be Rs. 2124/- and excess amount charges is Rs. 5620/- (Rs. 1124 – Rs. 1000 (allowable) * 5 days = Rs. 5620/-) only a disallowable charges as per your policy terms & conditions but you have deducted excess amount as per actual working. According to our working, still you have short paid Rs. 10, 553/-.

After convincing the above fact, still Insurance CO. is not replying to us. As we are coming from middle class family, we need this money and also have importance of such a big amount Rs. 10, 553/- hence request you to pl look in to the matter and inform Insurance co. to clear our money.