New India Assurance — Cheating by New India

Address:

Mumbai City, Maharashtra, 40083

Respected Sir/ Madam,

I myself Rishikesh Tiwari from Mumbai would like to draw your urgent attention on this.
This refers to my Mediclaim Policy Number[protected] dated 05/01/2016; I have been taking New India Assurance Co Ltd Mediclaim Policy from last 8 Years. But never claimed anything as we never faced any issue of hospitalization as such so far. Last 8 years, everything was ok as we never faced any issue in claim with New India Assurance co Ltd;

Recently my wife was admitted to a hospital (Sidhivinayak Hospital) which is near to my home in emergency on Saturday 25/06/2016 and she gone through an operation on SUNDAY 26/06/2016 and finally discharged from Hospital on Monday 27/06/2016; I incurred around 42000/- total including Hospital and Medicines etc. in this. As I had Mediclaim for Rs.1 L each family member- I put a claim to Health India TPA for Rs.40560/-; after almost one month- I got NEFT of Rs.17235/-; I tried approaching Health India to share the details and I kept calling - when there was no revert/ no response- I decided to personally visit Health India Office and today I visited Health India TPA office. I was very much shocking and surprising to after my visit as got nothing but embarrassing and almost irritation - nothing else. They gave me some clause reference and asked to approach Insurance co;

In this regard I am following up with New India office from last three months but regret to inform you that in spite of replies to my query and solution to my issue- everybody is trying to wash their hands. The worst part is that the Branch of Issuing my Policy and the Agent they themselves had some understanding and closed the case now. and The replies are just formalities; Below trail mails are for your reference. I have received only 4 pages from Insurance companies which I have attached for your reference. I have not received any other document from insurance company.

I had raised following concerns to New India but never received any satisfactory replies so far:

What is TAT of settlement of such claims- why Health India took 1 month to settle the claim. What is guideline of IRDA? Does any review from New India is being done? If Yes, what action has been taken in this case?

Why Health India TPA had not shared the details to me. What is the policy? why I have to visit personally in their office for this. Since I have not received the details- I had no option then to visit the office- who is reviewing these?

When I visited Health India TPA Office- I met Dr Jigna who claims to be Asst Manager of Health India- She told me that my limit is 1L and in this limit I have been certain limitation of everything. and if I have any issue I should approach Insurance co- I told him then why you have settled 17235-- you could have thrown the entire claim file to New India Assurance co only. My basic question who is Health India to decide my claim and deductions there in? Why this third party concept- their (TPA) T & C is not disclosed at the time of taking policy? The behaviour of Health India TPA was literally shocking and not at all customer friendly. During discussion I have been told that within 1 L limit- this much claim can be passed- and that’s why considering the cost of index- I should go for higher premium policy? What is this? Why they are advising me??? Have you appointed to increase your sales target???????

New India Assurance co never gave me anything in writing on such terms and condition from last so many years and therefore I am not going to accept anything not acceptable clause as such.

I have been penalised as I choose the hospital which is near to my home because of emergency. What could have been done if I would have chosen a hospital where cash less facility is available. I could have easily taken all the treatment Free of Cost. I kept faith and trust on New India which in reverse resulted in to systematic and organised cheating and fraud.

As per so called Doctor Jigna- the charges of Doctor during operation and Anaesthesia are higher- who will decide which doctor will charge how much? That too on Sunday. and before operation do you expect me to call you and confirm whether I should go ahead for operation for this or that doctor whose charges are this and that amount- This is seriously ridiculous and not accepted at all in any case.

Health India TPA is making joke of it by releasing around 40% of my claim and deducting almost 60% of the amount. According to them everything is on higher side- why this Health India TPA was not in picture with their T & C while taking policy. why this T & C was not shared in writing from so many years.

As per the details they had given everywhere they have mentioned clause 1, 2 C & D----- Please let me know which clause is this? Why these clauses are not updated to me in advance while taking the policy. You never shared me such clause from last 8 years- now when i am putting claim- you are coming out with clauses- which I am not going to accept in any case.

I have another claim of around 5-6K (post Hospitalization in this treatment) but now I am afraid of submitting any claim to any unprofessional company anymore.

Since I have taken policy and paid premium to you - this is your basic responsibility to take up this issue with your so Called Health India TPA- why should I waste my energy and resources with them.

Does New India Take feedback from customer on claim settlement? if yes- what action they take in case of any grievances?? Would like to know what action you have taken in this case against my Grievances?

Do you have any review mechanism of operational efficiency of your so called TPA? On what parameters you have selected and hired this so called TPA?

What action New India going to take against the concerned against non-reply in this issue?


Sir, In the entire case- New India and Agent both has some understanding and they are trying to close the case without my prior intimation. In spite of my repeated follow up from last 3 months, they could not able to give any satisfied reply. Also they could not able to produce any of the documentary evidences in which they can prove that the booklet (which they had sent me now in Sept 2016) is being issued and given to me in past. Trust me, this is purely systemic way of fraud my New India Team. Sir, I have never expected such situations but it was my unfortunate who choose New India Assurance Co Ltd for Mediclaim. The below trail mail and attachment is self explanatory. Request you to please help me out in concluding this case positively at the earliest. I sincerely apologies for the inconvenience cause to you.

Expect your intervention to conclude the issue at the earliest. Please do the needful and oblige.

Thanking you

Rishikesh Tiwari
[protected]