Oriental Insurance Company — rejecting partial claim under mediclaim on wrong ground
401, Om Sadan, 36th Road, Bandra,, Mumbai, Maharashtra, India
Vivishalahinduja on Apr 30, 2019
MEMBERSHIP NO. O[protected] OF VISHAL HINDUJA ORIENTAL INSURANCE CO. TPA: RAKSHA TPA
CLAIM NOS.: -[protected], [protected], [protected]
I have submitted above valid and perfect claim towards BREAST CANCER OF my wife, BHAVNA VISHAL HINDUJA. I state that
I have mediclaim insurance with you only.
This is my very first claims.
I categorically state that I have submitted all the relevant documents/support to my claim in ORIGINAL.
Due to lack-luster attitude of your RAKSHA TPA, my claim was delayed and had to make series of follow up and verbal fight with the representative.
the claim passing officer in Raksha TPA, Mr. Sameer Satpute never lift the phone nor call back. Please you try and confirm.
On complaint to higher up, they agreed and apologized for the delay.
NOW I DO NOT COMPLAINT ABOUT THE SAME, BUT COMPLAINING ABOUT NOT PASSING PART OF CLAIMS ON THE GROUND SUPPORTING NOT ATTACHED.
I complaint to higher up in RAKSHT TPA again of the same and request to check at their end again. He assured me to do the needful on re-submission of claim with photocopy of all supporting medical papers/report
I have submitted part claim that was rejected vide claim no [protected]. Out of the same, they passed only Rs.3000/- rejecting Rs.7050/- again ground that ORIGINAL NOT SUBMITTED.
Again Claim no [protected] was passed partially, with Rs.1500/- deducted on the same ground.
I have written letter to them that I have attached for your ready reference.
I STRONGLY PUT THAT NOT A SINGLE TIME I HAVE FAILED TO MISS ATTACHING ANY SUPPORTING DOCUMENTS, AS CHECKED AND RECHECKED AND AFTER PINNING IT GOES FOR MAKING STATEMENT. MY PEON EMPHASIS THE COUNTER TO CHECK ALL ATTACHED DOCUMENTS BEFORE PUTTING STAMP OF ITS RECEIPT. IT IS THEIR DUTY TO CHECK THE PAPERS PROPERLY AND THEN PUT STAMPS OF ACKNOWLEDGMENTS. I FEAR FOUL PLAY BY THE STAFF, AS I HAD HEATED ARGUMENTS FOR NOT CLEARING CLAIM FOR TWO MONTHS INITIALLY.
PLEASE LOOK INTO THE MATTER URGENTLY AND REPLY. HOPE YOU UNDERSTAND THE SITUATION BETTER. HOW COME THEY GOT ONE ORIGINAL AFTER REJECTING IT AND HOW COME OTHER ORIGINAL ARE MISSING?????
I STRONGLY OBJECT ON PASSING CLAIM PARTIALLY AND REJECTING ON THE GROUND AS NOT RECEIVED ORIGINAL. WHERE CAN I BRING AGAIN ORIGINAL? YOU CAN VERY WELL AUTHENTICATE ORIGINALITY AT RAKSHA TPA SIDE, IF THEY HAVE MISPLACED IT.
I CLAIM RS.8, 250/- TOWARD CLAIM NO. [protected], RS. 1800/- TOWARD CLAIM NO. [protected] (COMBINE CLAIM NO [protected] ON RE-SUBMISSION) AND RS.1500/- TOWARDS CLAIM NO [protected].
ENCL.: - LETTER TO RAKSHA TPA
[Apr 30, 2019] Oriental Insurance Company customer support has been notified about the posted complaint.
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