Dear sir, My self and my wife has mediclaim policy from future generalii No.2011-H0023996-FHI.

My wife was ill and got hospitalised in Adinath Hospital, Indirapuram on 02.09.2011 as a case of dengue fever.

Hospital send request for cashless which was refused by Insurance compony on baseless ground and ask for rembursment.

My wife remain admitted till 07.09.2011 and Hospital raised a bill of Rs. 33752/-

Insurance person visited the hospital and varified the presence of pateint in Hospital.

Initially insurance compony was not resonding for claim and when ever contacted gives the answer that claim is under process but when complaint was registered with IRDA

Insurance compony rejected the claim on the following grounds;

1. Pt. has given a wronge residential address - How a residential address can be cause for no claim even when Pateint presence in hospital was confirm=
ed by insurance compony and all corospondance even renewal of policy was with same address.

2. My self is a doctor and director of the Adinath Hospital - how does being my self doctor and director of treating hospital leads to no claim for insura=
nce compony.

Insurance compony representative repeatedly visit the address and harash my wife and her sister in law once they was alone in the house.

Now you are requested to see the matter and ask insurance compony to pay the claim with intrest and panalty for harashment.

Thanks with regard

Jain

hi, I need to newly get medical insurace for both my parents both of age 59, my Father has pre existing disease - Diabetes and my Mother does not have, so please advise on which insurance I can take. I will need the maximum renewal age. Thanks Wincy

my mother is insured by icici prudencial life insurance but it is not paying my claim. icici pru life is very bad company. it is not paying any one claim if any misshappening. i have lot of people who is suffering such tipe of problem by ICICI pru life. i am suffering since last 2 year. how can i get my claim?

I HAD FILED AN HEALTH CHECK UP CLAIM WITH RAKSHATPA FARIDABAD ON 9-06-2010.AND SUBSEQUENTLY I HAD CONFIRMED THAT THE SAME WAS RECD IN THERE OFFICE ON 10-06-2010.I AM INSURED WITH NEW INDIA ASSURANCE COMPANY ROHTAK.NOW THE TPA IS NEITHER REPLYING NOR PAYING MY CLAIM .WHAT ARE THE OPTIONS AVAILABLE TO ME .IF I TAKE CLAIM TO OMBUDSMAN WHICH IS IN CHANDIGARH.I SHALL HAVE TO WASTE ONE DAY TO ATTEND HEARING AND SHALL HAVE MONETARY LOSS ALSO .IS THE TPA GOING TO REIMBURSE THE EXPENSES I SHALL DO FOR GOING TO CHANDIGARH IF THE CASE IS DECIDED IN MY FAVOUR. IS THERE ANY PRECEDENCE AND THE TPA BEING PENALISED FOR HARRASING THE INSURED PLEASE ENLIGHTEN ME ON THIS.

is there any mechanism to lodge a grievance complaint to LIC ombudsman,kochi through Online service

I have a query, my insurance agent had done some forgery, he had done shifting between available funds with out my knowledge, and so there is loss of more than 1200 units in my policy. can any body tell me how can i bring him down?

sir,further to GAJANAN's comments. It is true in spirit. But,the practical experience is the Ombudsman personnaly calls the Insurere/TPA officer. The opposite insured/ claimant has to put in his argument. That is the imbalance that has been brought forward. GAJANAN is right in saying that it is on submitted written documents, the ombudsman has to given decision.But, the scenerio is different. It would not be a big deal if the less informed Insured gets the help to put his correct submission in contrast to callous mechanical attitude adopted by TPA/Insurers in the first instance.

Sir,
Why is there no transparency? Why does the ombudsman not allow the insured to take help of the expert at the hearing? There is imbalance between the Insurer (with all insurance/mediclaim acknowledgement)& the Insured who is ignorant of intricacies of Insurance/Mediclaim terminology. This is imbalanced justice.

My Company chose a different Health Plan with another company this year. They cover Colonoscopy every 10 years instead of 5 years. I had colon surgery 2 years ago for a small polyp. The doctor wants me to have a Colonosciopy this year. They will not cover it because they say it is pre-exiting. Is this legal, I did not change Insurance Plans, my company did. My doctor considers this preventitive, the Insurance Company does not, and will not cover it. I am 60 years old. I also took out disability insurance so that I would receive $1800 a month, if I get sick. United Health is saying if it is related to your colon you will only receive the $1,000 the amount you had previously. How is this fare, if I am paying to receive $1800, why would I only receive the $1,000. Is this legal?

As The maximum limit for the amount under dispute is Rs. 20 lakhs...with whom should i file a complaint for amount greater tham 20 lac