Oriental Insurance Company — Grievance against non-settlement of health insurance claims

Address:

380051

Oriental Insurance Company Ltd.,
Customer Service Dept.,
Head Office,
“Oriental House”
A-25/27, Asaf Ali Road,
NEW DELHI-110002

Dear Sirs,

Re: Grievance against non-settlement of health insurance claims
JIO-HNI Policy No. 530000/48/2016/507 (Period:[protected] to[protected]
Insured person : Mrs. Jyotee D. Shah (Mother)

I invite reference to my e-mail dated[protected]copy attached) registering my complaint against non-settlement of claims lodged under the above referred policy in connection with hospitalization of my mother. I had also sent to you copies of “Pre-repudiation Letters” (3) of TPA, Health India TPA Services Pvt.Ltd. which were forwarded to me by Jain International Organisation (JIO) in response to my enquiries about the status of my claims. Though the said letters were found to be addressed to the Divisional Manager, Oriental Insurance Co.Ltd., CBRO Mumbai, Oriental House, Jamshedji Tata Road, Churchgate, Mumbai, they were giving sufficient indication that the decision conveyed thereby was purported to be the final decision of your policy issuing office. It is in that circumstance that I, taking cognizance of the contents of the said letters, sent the e-mail referred to above presenting the genuineness of my case and requesting you to issue necessary direction to the TPA to desist from maliciously misinterpreting the provisions of the policy of insurance and to settle the claims. Unfortunately, it seems, my letter failed to attract your attention. Since however you have neither disowned the decisions conveyed by TPA in their letters nor have you contradicted them, I construe that you are only inclined to concur with the unjust decision of the TPA to repudiate the claims. In this context, I consider it relevant to draw your attention to the fact that the reason for repudiation of my claims as shown in the letters of TPA is totally unfounded, biased and contrary to the provisions of the contract of insurance and hence your action or inaction in the matter of performance of the contract amounts to deficiency in your services.

In view of the foregoing, I again request you to examine the cases in question taking into account the fact mentioned in my letter under reference and with objectivity and fairness and arrange settlement of my claims immediately on receipt of this letter.

It may however be noted that if I do not receive any communication from you within 15 days of your receiving this letter, I will presume that you are not interested in resolving the issue and accordingly, I will proceed legally to recover the claim amount with interest and cost.

Thanking you,

Yours faithfully,

KUNAL D. SHAH

c.c.to: Divisional Manager,
Oriental Insurance Co.Ltd.,
CBRO Mumbai, Oriental House,
Jamshedji Tata Road, Churchgate, Mumbai.400020

c.c.to: Jain International Organisation.
103, Midas Tower,
Bhau Dati Road Extn., Sion-East, Mumbai – 400022.