Ministry Notification

18. Power to make Ex-gratia payment: If the Ombudsman deems fit, he may award an Ex-gratia payment.

MISCELLANEOUS PROVISIONS:

19. Advisory Committee: An Advisory Committee, consisting of not more than five eminent persons, shall be notified by the Government to assist the Insurance Regulatory Authority to review the performance of the Ombudsman from time to time. The Insurance Regulatory Authority shall decide the time, venue and forum of such meeting. The authority, after discussing the matter with the Governing Body, may recommend to the Government appropriate proposals for effecting improvements in the functioning of the Ombudsman. In the light of recommendations made by the Insurance regulatory Authority, the Government may carry out such amendments to these rules as they may deem fit

20. The Ombudsman shall furnish a report every year, containing a general review of the activities of the office of the Ombudsman during the preceding financial year, to the Central Government, and such other information as may be considered necessary by it. In the Annual Report, the Ombudsman will make an annual review of the quality of services rendered by the insurer, and make recommendations to improve these services.

21. Recommendation of the Insurance Council: The Insurance Council may suggest to the Ombudsman such recommendation as it deems fit, and which, in its opinion, will enhance the utility of the annual report, and also so that the objectives of the rules are clearly analyzed in terms of the activities for the year under review. The Ombudsman in this report will incorporate suggestions for long-term improvement of the insurance sector.

[F. No. 56/32/97 - Ins.1]

D.C. SRIVASTAVA,

Director.

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@Guest

Dear Sir/Madam Mera name Neeta Parmar hai or me Bhaynder,-east Mumbai, Maharastra me raheti hu mene mari Daughter ko fever tha or use ko lekar me Dr. Priya clinic me gai thi or unhone muje unke husbund jinka bada hospital hai [SAI GANGA HOSPITAL] vaha muje meri ladki ke sath bheja jab me vaha gai to Doctor ne meri ladki ka check up karne ke bad puchha ki aap ka mediclaim hai to me ne kaha ha hai or unhone meri ladki ko admit kar diya, usko 2/7/17 se leke 7/5/17 tak hospitalize rakha or 43000/- ka bill banaya jo mene vo paise mere gahene girvi rakh ke cash Doctor ko de diye. Usake bad jab mene mediclaim ke liye Jo paper Doctor ne diye the vo Paper mene Apollo Munich Health Insurance Company me diye, to company ne mera claim Doctor ki galti batake reject kar diya

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shivdutt

Dear Sir,
Since year 2004, I and my wife have a med claim insurance policy of United India Insurance Company for Rs. 1,50,000/- each of us [Totaling Rs. 3,00,000/-].
In year 2012, I suffered a heart attack and availed med claim benefit. Thereafter, I felt that the insurance sum of Rs. 1, 50,000/- each which seemed to be adequate in year 2004 is now insufficient to cover present day expenses owing to market inflation.
Thus at each subsequent renewal, I am requesting local office of United India Insurance Co. for increasing the sum insured. But I am being refused for increase in sum insured because I have suffered heart attack in 2012.
Besides, my wife is also denied revision in sum insured because she had availed med claim for a gyno myomectomy surgical procedure in 2011.
I would, please, like to know â€“
- After having availed couple of med claim benefits in these years, Canâ€™t we revise the decades old sum insured for our continued med claim policy now?
- If yes, how to do it?
- If canâ€™t, would like to know regarding appropriate rules in this regard.
- Shiv dutt chadha

ATULM

I filed my complain against UNITED INDIA INSURANCE CO.LTD IN MUMBAI OMBDUSMANS OFFICE IN AUGUST-2012 CASE NO.OF THE SAME IS 953.NOW THEY ARE TELLING ME THAT,THERE IS NO OMBDUSMAN APPOINTED and CASES FROM DEC/2011 ARE PENDING I AM UNABLE TO UNDDERSTAND WHAT IS HAPPNING? WHEN LL IT BE APPOINTED,TO WHOME SHOULD I CONTACT REGA .THIS

mpoovali

i had taken a health insurance policy from, Medical check up was conducted and they informed me that I have complaint of Diabetic and so any claim related to that will be disallowed. I never had diabetic problem and I took another test to confirm this, my sugar level was found 98. I am requesting star health to provide me a copy of their report which they are refusing- what should I do?

jaina

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