Oriental Insurance Company — Claim Unsettled for more than 2 months and no update yet

Address:	Mumbai City, Maharashtra, 401101
Website:	orientalinsurance.org.in

Hello Sir,

My name is Dipesh Shah.

I am writing this email to bring to your notice about the discremental and unsatisfactory service been offered by your Insurance Organisation.

The Policy and Claim Details are as below -

Policy number - 121200/48/2017/11020
Claim Reference Number - [protected]
Insured Code[protected]

This is in context to my sister's medical insurance claim which I claimed recently amounting to Rs. 27862.

She was suffering from Severe Migraine and was admitted to the hospital for the same. She underwent treatment for almost 3 days and she had a policy with Oriental Insurance from almost more than 10 years now. The Ploicy was of Rs. 50000 initially and since last 3 years, we have increased the Sum Insured to Rs. 3 Lakh.

After discharge, we submitted all the documents to RAKSHA TPA. It is been 2 months almost now that we have submitted the documents and when we are calling for an update, we are been told that THE DIAGNOSIS IS NOT CONSIDERED TO BE AN ACTIVE LINE OF TREATMENT. I really dont understand this issue.

WE HAVE BEEN PAYING THE PREMIUM FOR THIS POLICY SINCE 10 YEARS AND WHEN WE ARE CLAIMING FOR THE FIRST TIME THINKING THAT WE ARE SECURED WITH AN INSURANCE POLICY, IT IS PEOPLE LIKE YOU WHO BREAK OUR TRUST.

I really understand the delay behind this process. This is the reason why Private Companies are much preferrable when it comes to Service.

I have been sending email to RAKSHA TPA (Swati) and Oriental Insurance (Dharmendra and Smitha) since a long time but there is no response from their end. They are not even bothered about the customer who is facing severe issue and seems to be Super Careless.

I have been disappointed from Oriental Insurance after paying a premium for almost 10 years now and without any doubt would have to migrate to a Better Insurance Provider who has the capability of paying the claim without giving any valid reason.

I have not yet received any letter or email from Oriental Insurance about my UNPAID CLAIM and there is no where menioned under any clauses in my policy about the reason due to which the claim is UNPAID.

I am hereby lodging a complaint against this onto the Consumer Forum, PMO, IRDAI and will need to bring their involvement on this issue in order to settle my claim.

It is the hard earned money that we have paid you as a PREMIUM for the past 10 years and under any circumstances, it is your duty to meet upto the customer satisfaction.

I hereby need a prompt resolution on this without any more delay and look forward to hear from you.