Oriental Insurance Company Complaints & Reviews

Dear team..
We means our complete family insured from oriental insurance.. We did nt claim.. But my father in law admiited in hospital.. And when we claimed for this.. Hospital bil approximatly 2 lac 20,, andinsued amt is 150000,, but compnay provide just 107000... So in which behalf they provide.. May be some deducted..,, provide maximum to maximum amt

I had purchased an insurance policy for my samsung j2 phone, it got stolen, i made police complaint, police tried to search it, and later gave me no trace report.
Alongwith all other requisite documents, i submitted insurance claim with w&ia services.
They kept asking for documents, initially w&ia guys doesn't pick up the phone for guiding towards submission of claim, their mobile app doesn't accept the claim and keep showing error, they need no trace reports, but format is not easily available, police department takes time in complete verification, before they issues no trace report. Above are few reasons for delay in submission of claims.

Later w&ias tean confirmed they are ok with claim and it is pending with insurance company.
I followed up for payment, i have around 34 emial communication with w&ia, in larer communications, they kept giving me assurance that it a good claim and will be settled by insurance company. Exact wordings were "please wait the insurance company should soon settle your claim as per the merit of your claim."

One fine day, they stopped taking calls and saya my claim is rejected by insurance company, due to delay in submission.
This was the only letter, which says that my claim was submitted late, there was no other such communication in this regards.
I am sure these companies for theft insurance are looking for any excuse and rejecting the claims, i had purchased policy from reliance retail limited, but there is no support in this entire process.
These kind of loots should be banned or action should be taken against responsible persons and companies.
I have gone through lot of mental harassment by this entire process.

My wife was hospitalised with jupiter hospital twice on april 20th 2017 to april 25th 2017 and 25th june 2017 to 30th june 2017. Following is the detail of our complaint letters to health tpa and oriental insurance for your refrence.
From:
Nita pankaj panchal/pankaj babulal panchal
C-1404, mahavir universe maven chs ltd,
Off l. B. S marg, next to kukreja complex,
Bhandup west,
Mumbai – 400078.

Dear sir/madam,

Subject: complaint against repudiation for 2 separate claims for reimbursement.

I the undersigned pankaj babulal panchal holder of the happy family floater policy of your company initiated on 07th july 2014 policy nos. As follow:
1. 131100/48/2015/5626 issue office name : mcdo20
2. 131100/48/2016/4420 issue office name : mcdo20
3. 131100/48/2017/3204 issue office name : mcdo20
4. 131100/48/2018/3331 issue office name : mcdo20

Claim no 1. April 2017.

My wife ms. Nita pankaj panchal who is the insured person in these policies was first admitted to dhanwantary hospital and intensive cardiac care unit (Mulund west) on the morning of 20th april 2017 at around 5:30am with complain of chest pain, nausea and vomiting where she suffered cardiac arrest and was given cpr and transferred to jupiter hospital (Thane west) at 8:05am to ccu 3 (Emergency assessment form attached). She was discharged on the 25th april 2017. Subsequently the claim was submitted claim no. 131100/48/2018/000608 with claim amount irs. 4, 13, 780.00.

We have received a pre repudiation letter stating reason:

Nita p. Panchal has submitted claim for acute anterior wall mi with vf with lvf in jupiter netralay. On scrutiny it was found that the ailment in this case has four years waiting period as patient is having past history of htn since 2000 as per doctor’s consultation note and the ailment is hence pre - existing. Insured has submitted policy copies from 14-17 as per clause 4.1 of new updated policy terms and conditions this claim stands repudiated.

To which we now submit the letter dated 10th may 2017 from the admitting doctor dr. Navin r. Davda which clearly states no past history of ihd and a subsequent letter dated 4th august 2017 which substantiate the claim of no past history of ihd and that the same has happened during her admission on 20th april 2017. (Both letter copies attached).

The above explanation is very clear and your reason of preexisting ailment is not valid hence we request your authority to look into the matter and reconsider our claim.

Attached documents at the time of lodging the claim no.1 at your andheri office and health tpa:

1. Copy of repudiation letter dated 2nd august 2017.
2. Letter from dr. Navin davda dated 10th may 2017.
3. Letter from dr. Navin davda dated 4th august 2017.
4. Admission history from jupiter hospital dated 20th april 2017.
5. Emergency assessment form from jupiter hospital dated 20th april 2017.
6. Jupiter hospital discharge letter dated 25th april 2017.
7. Claim form duly filled dated 27th apr.2017.

Claim no 2. June 2017.

My wife ms. Nita pankaj panchal who is the insured person in these policies was first complaining o[censored]rine infection on 23rd june at dr. Mahajan urology clinic at ghatkopar east and was prescribed medicines by dr. Ramesh mahajan for 5days and the next appointment was on 28th june 2017 (Letter attached).in the morning of 25th june on seeing no improvement and the situation getting serious she was admitted to dhanwantary hospital and intensive cardiac care unit (Mulund west) on the morning of 25th june 2017 at around 9:00am with complain of fever and chills, nausea and vomiting, abdominal pain, loss of appetite, loose motion etc. (Discharge card/doctor davda’s discharge letter attached) after initial medical treatment she was transferred to jupiter hospital (Thane west) at 19:27pm to ccu 2 (Discharge summary attached). She was discharged on the 30th june 2017. Subsequently the claim was submitted claim no. 131100/48/2018/002469 with claim amount irs. 1, 39, 651.00.

We have received a denial letter stating reason:

Hi-oic[protected] of nita p. Panchal
We have received the request for cashless hospitalization vide fax dated 06/27/2017. We have verified the coverage terms and conditions as per insurance plan.
On primary scrutiny of your request, we regret to inform you that we are unable to sanction cashless benefit.
Policy is in 3rd year, present hospitalization seems related to h/ohtn dm, hence cashless denied under clause 4.1 (Preexisting diseases).

To which we now submit the letter dated 8th august 2017 from the admitting doctor dr. Navin r. Davda which clearly states that it’s for the first time she has suffered from this ailment on 25th june 2017 (Letter copy attached).

The above explanation is very clear and your reason of preexisting ailment is not valid hence we request your authority to look into the matter and reconsider our claim.

Awaiting your early reply in this matter.

Thanking you,

Pankaj babulal panchal

This is regarding theft of my bike dl7sbh8061 which was purchased second hand in the yr 2012... Delivery receipt attached. I had shown those keys at the time of inspection and same were submitted... After 4 yrs of regular insurance with malviya nagar branch, there was no problem.

Kindly intervene and get the claim settled on the earliest

Regards

Umesh saluja
[protected]

Hi there, i met with an accident on[protected] at 7.10pm. Was hit by speeding bike in rear left side of bumper and car was slow. Because of strong hit and may be screw in mudguard, rear left tyre got bursted at the location. As car was in motion rear excel and rear left hub also got harmed. Because of crowd and safety purpose i parked my car away from the location. After leaving my wife to safe place when i came back to car, i got to know that police crane took away the car to sadar police station hanumangarh. (Rear rim thrashed by police crane that time).

So the actual loss (As per maruti workshop): 1. Rear bumper
2. Rear left light
3. Rim
4. Tyre
5. Hub
6. Rear excel
7. Rear ac cooling window
8. Alignment
9. Other dents

But the surveyor says i can only pass bumper and tale light.

Note: we have bumper to bumper insurance which means we don't have to pay more than 1000rs.

As we have paid maximum to you guys then why would we pay at our own? Why do your company insurance full when your guys can't approve?

We need this full claim and i am gonna complain to higher authorities until any appropriate action.

Car no. Rj31cb0387
Surveyor: rp godara
Workshop: audi motors hanumangarh

Dear,
My claim pending last 1 year. My claim no any document pending regading health insurance claim. My claim is health insurance regarding my father accidental injury. My claim sumbitted on date of 25 may 2016. My claim all document submitted oriental tpa. Current claim status no claim regarding last 8 month. Personally visted but not answer and not reopen claim process by till date. Please reopen claim process further.

Papers for claim under above policy were submitted on 24.07.2017 to health india tpa pvt. Ltd mumbai but in spite of repeated reminders and followup no claim is paid. The complaint has been sent to oriental head office new delhi but nothing is done. Kindly arrange for payment with penal interest as per irdai rule failing to which complaint to be registered with insurance ombudsman.

Mahavir h jain thane

To,
The branch manager,
Oriental insurance,
Jaipur.

This is inform you that i have taken the insurance cover of my car rj 14 lc 2199 (Hyundai creta) against cover note no. 500602 (Other details will be in the history of this email), further i have claimed for accident happen with the car as on dated 30th sep’17 (You can go through the email history for verifying the same), this is very regret to tell you the still after 8 months i have not received the claim amount and when i sent my staff person to the branch, branch people said that i have not applied for claim yet. So this is some thing very ridiculous after looking at the history of this email.
Well i have suffered a lot and on continuation of this i want to share this thing also that on renewal of policy i have not taken the benefit of no claim bonus.

Now this is my straight warning to the senior officials of the branch that either my claim should be settle in couple of days otherwise i will go to complaint in irda portal.

I assume that will receive a positive reply earliest.

Its a regret to say that your company services r too bad we have taken a policy and after some time we have a incident on that police & we register a complain in april & its a last of august uptill the case was not solved. On time of insurance we assured that our service will be best but its very sad to say that ur services of company is too bad after this compalin if my problem is not solved in three day i will take legal action.
Complain no is 153500/2018/00024

I have an Oriental motor insurance policy with Policy No. 252800/31/2017/25257 bought on 10th of Feb 2017 and Vald till 9th of feb 2018. On 25th June 2017, I was travelling to Bulandhahr, U.P. when I met with an accident. We were 5 members in the car and all received serious injuries and the car is also destroyed as it was hit by a bus from behind. I filled in the claim form on 28th of June 2017 and also sumitted police report and damage estimate for my Honda city car with registration no. DL 3C AK 6680. Now the responsibility for Final survey was given to a Surveyor that is Hori Lal Varshney. He did the final survey on or around 25th of July 2017. He has not submitted his final report and when I contacted him he asked me to negotiate on the claim amount which according to the policy is 1, 40, 000 rupees but he tolde me to take 10% less than the claim amount otherwise company wants you to repair the car outside at any worksho and will only give you 40% of the repair cost. According to the damage estimate Car is a case of total loss amd repairs will cost me around 7, 28, 000 rupees. I agreed on that and gave him a 100 rupee stamp from court on which he wrote a consent according to which I will be getting only 1 lakh and not 1, 26, 000 as told to me by Mr. Hori lal. I have complete faith in Oriental insurance company and I really hope that they will help me out of this situation and help me get the amount I was promised at the time of purchasing the policy. I have been purcjasing policies for my different cars from oriental and I want this case to be dealt in a way that my trust in this company is not broken.
My no. is [protected] and [protected].
I really hope to get a positive result of this complaint.

Hello sir..
I am your policyholder having plcy nmbr 262100/48/2017/2216 naming jyoti saroop. I went out for some work at that place i (jyoti saroop) suddenly get heart attack. Aftr that i went for treatment. I admited in hospital where i got treatment. I gave medical policy to hospital to meet the benefit of this policy.the dealing assistant of that hospital sent the medical policy to insurer. But now they object on some issue. Firstly he said . Provide bank statement which show the insured person give the payment . I sent that statement to insurer. Aftr that he said to provide the previous policy . I provide the previous policy numbr which also shown in new policy schedule. I provided each and every thing concerned to policy to you.
So .. take the matter in priorty and give us the validate reply and claim settlement.

Thanks

My truck no nl02l2864 theft from aurangabad, (Bihar) on dated 31/03/2015
My policy no is 332300/31/2015784 through oreintal insurance gaya branch (Bihar) my clam no is 332300/31/2016/000001. Final report of police and judge ofaurangabd court submitted to insurence company. Every document is given to the insurance company as they demand but i have not got my insurance claim. I am unwantedf disturbed by insurance compny.
So i request you to please take a prpoer action on my case as soon as possible.

Refer to ro chandigarh letter dtd 21.03.2017 ro chd has selected me as crm club member, to get benefits under crm member i have deposit all necessary documents to branch sangrur on dtd 28.06.2017 but till date i have not raceived any reward amt from branch. I visited many times to branch for this regarding but branch manager told me that reward amount is excess from my financial authirity so i have already sent vouchers for approval to do but divisional manager is not interested to pay reward amount to you without ransom money, i am helpless in your case. Your are requested to look about the matter and help me get raward amount from these currupt officers.
My contact no is [protected]

I have bought a health insurance from oriental insurance for my dependent parents and getting it renewed for last approx 10 years that too without any claim. Sum insured was of rs. 1 lakh for each parent. This is the first time i lodged a genuine claim under which our total expenses was rs. 97000 approx which is well within the limits of our sum insured but the amount rendered to us for this claim is only rs. 28000 approx. I got a detailed sheet wherein the exact calculation was given, but i am surprised to see they deducted 77.8% for all pathological tests like mri and others and have not paid a single penny for medicines. They only paid for room rent (That too 1% of si) which is fine but nothing more. When i called, they misbehaved with me and their staff mr. Rajeev duggal who is branch head disconnected the phone on my face without explaining anything professionally and talking arrogantly with us

Subject-regarding wrong deductions in my claim.
Dear sir/madam,
I mrs. Shobha jain (Oswal) bearing policy of your company, pol no is-163600/48/217/6003. I am having this policy since 2006 without any break & had benefit of several claims before this. I have disease (Carcinoid syndrome) which requires frequent treatment.in this claim tpa has deducted rs.33600 wrongly stating inj sandostatin is not related to current ailment. The same inj was given by my treating dr. Minish jain in my previous claims which was correctly paid by tpa.
Claim details :-
Policy no -163600/48/217/6003
Claim no[protected]
Date of admission - 23/02/2017
Date of discharge-24/02/2017

Policy no. 191300/31/2017/15270.
I here declare that my policy number given below. Cause of accident my vehicle was totally damaged and the vehicle was in thw category of total loss. So, i request to see my policy and provide claim, jaika compnay (Tata motors) estimate of calim rs. 18, 43, 669. Which is more than the idv value of the vehicle i. E of rs. 13, 00, 000.

Mediclaim policy no: 442600/48/2018/1, claim no:14915526
Patient admitted at mosc medical college kolenchery on 17/7/2017 & submitted all documents for cash less treatment. But tpa medi assist rejected the cashless without explain any reason. Severe negligence from the tpa. I think cashless is not a bounty of tpa. I need cashless & justice urgently....

Subject:- our claim for loss at our processing unit in village –saidpur, derabassi with reference to insurance policy no. 231400/11/2014/25 dated 28.05.2014 (Standard fire & special perils) & policy no. 231400/48/2014/132 dated 28.05.2014 (Burglary standard policy)
Respectfully it is submitted as under:-
1. That the insurance policy issuing office was sco 20, 2nd floor, phase 1, mohali, chandigarh – 160055.

2. That the heavy rain had taken place at derabassi on the intervening night of 18/07/2014 and 19/07/2014, due to which we faced heavy loss in the shape of stock of fabric cloth and finished suiting, shirting material lying in the processing unit and also the plant and machinery got damaged. The unit was running and suddenly heavy rain water resulted in heavy flow of water inside the unit to almost 6 feet deep.

3. That we had already submitted the claim intimation vide letter dated 19/07/2014 to your office. Subsequently, the surveyors m/s vinod bhan & associates, s. C. O 179-180, top floor, sector-17-c, chandigarh visited the premises on same day i. E. 19/07/2014 and m/s vinod bhan & associates vide written communication asked us to submit certain document and all the document which were require from the company were submitted vide letter dated 14/05/2015.

4. The technical report of damage occurred at amartex industries limited at village saidpur due to flood, was also submitted along with all the relevant bill and document.

5. That in spite of our regular follow up and visit to the insurance company we have not received any reply till date from the insurance company regarding claim.

6. That we have not received any reply till date from the insurance company.

To

Head office: hyderabad
3rd floor, parisrama bhavan,
Basheer bagh,
Hyderabad - 500004,
Telangana, india.


Sub: application for reimbursement of mediclaim of e-meditek and policy no 215600/48/2017/4786

Sir,

My claim was still rejected & i was asked to apply to for re-reimbursement as physical verification would be done. I agreed, paid the bills and applied for re-reimbursement. I was told that a verification will be done by experts who will solve the issue

T makes very third class image in the mind of clients.
I have find the another good agent that's why i'm still with oriental otherwise there many good & reputed company in the market, specialy at this time, where compition is very high.
So, please make sure that such kind of activity get stop asap.

.
I got a rejection letter of reimbursement of mediclaim of max from mrs. Beena divisonal manager of oriental insurance, barakhamba road but i have filled two claims
One of max hospital
And second of fortis hospital but she had replied on max hospital claim

I want to file a legal action because at present i have spend more than double insured amount of my victim
I would appeal that please file my case in irda cell and i would be present on hearing

I also enclosed the attachment of letter which i got from mrs. Beena divisonal manger of oriental insruance ltd.

I will also file the complaint to irda for the same, as it is not acceptable at all.


For sure i am going to log serious complaint against the oriental insurance co more to that i will specially share my experience in all the social websites so that others should not get in to this the oriental insurance scam, this is really pathetic. Single claim in entire year, that to for emergency issue which is not related to pre-disease or not covered like issues and claim rejected. I will make sure this message should reflect on every available social websites, whats app, facebook and to in newspaper. This kind of cheat companies should not be legal in india and will make sure by going legally to remove this insurance from all the hospital panels in india.

My wife is hospitalised right now and i have applied for mediclaim in e - meditek insurance ltd but i am so much disappointed with the service of e - meditek insurance ltd

From


Sunny arora
Policy no 215600/48/2017/4786
2677 outram lane
Kinsway camp
New delhi 110009
(M) [protected]

C/c sent to
1. Hon. Cm delhi
2. Irda cell
3. Pmo of central public information officer

The complaint which is given below:
—

I am not getting that why you should give the liasons to that company who does not commit and do not provide the mediclaim cash less when it is required

Now i m facing the two problem first my wife who is sufering from critical disease and she is admitted in a fortis hospital, shalimarh bagh and another i have to face monetray problem becaue right now i have to borrow amount from my realtive

Really already i send my case to the office of meditek insurance ltd but i dont get a response from my previouse claim

I request you to kindly take the strict action against meditek insurance ltd (The oriental insruance co ltd.) because my wife claim is being rejected by the e-meditek insurance ltd

Kindly response me fast because i could not able to pay the amount and i have already paid the premium of meditek insurance ltd

Kinldy reimbursement my medicalim as early as possible


I am sending the details of my policy which is given below

From
Sunny arora
Policy no 215600/48/2017/4786
2677 outram lane
Kinsway camp
New delhi 110009
(M) [protected]

I am writing this email to bring to your notice about the unsatisfactory service been offered by your insurance organisation.

The policy and claim details are as below -

Policy number - 211200/31/2018/2246

I am parveen kumar owner of vehicle number dl4caw1748, policy number - 211200/31/2018/2246. My car got damaged and after long follow up, it was surveyed by mr. Gurjeet juneja on 4th may, 2017 and i repaired the car at ring road honda, peeragarhi, delhi. I submitted my all documents on 4th may, 2017 to ms mandakini balodhi on the same day. I paid the money to honda service centre and submitted my bills to oriental insurance on 16th may, 2017. Now, i am seeking reimbursement of my bills under policy no. 211200/31/2018/2246 from last 2 months but oriental people are not replying to my calls and emails. I have submit previous insurance policy and ncb certificate as well to ms. Deepika. This is giving me physical and mental harassment as nobody of yours company is caring about my hard earned money. I did 2 personal visit to orientals' regional head office barakhamba road office.

Regards

Parveen