Exclusive HOLI Discounts!
Get Courses and Combos at Upto 50% OFF!
Upgrad
LCI Learning

Share on Facebook

Share on Twitter

Share on LinkedIn

Share on Email

Share More

Enjapally vijay   12 May 2017

Not settling the mediclaim benefits

Dear madam/sir,

I worked for a hospital for period of 1.5 years. in this duration management has given medi claim cards was supposed to give after completion of my six month. but they had given after 7 months. In this 7th month. my wife was admitted in non-network hospital due to maternity case. with reference to the mediclaim policy, i submitted my all bills with in the prior time of TPA company. after following up many times with management. i didnt get proper answer from them. lasty i contacted to TPA customer care, then they told that my wife hospital joining date is 4 days less than the date of endorsment with insurance company. But my management told me that they working on that to settle the claim. after few month later ie day before resigning . i got the mail from secondy party insurance company that claim is going to settle with one week. Now its been 6 weeks that my claim was not settled. what my question is endorsement delay is from my management side it is not my mistake. and they promised the benefits after prohibition was failed to give. pleasee suggest me that how do i approcah to get back my claim amount.



Learning

 15 Replies

Kumar Doab (FIN)     12 May 2017

Originally posted by : Enjapally vijay
Dear madam/sir,

I worked for a hospital for period of 1.5 years. in this duration management has given medi claim cards was supposed to give after completion of my six month. but they had given after 7 months. In this 7th month. my wife was admitted in non-network hospital due to maternity case. with reference to the mediclaim policy, i submitted my all bills with in the prior time of TPA company. after following up many times with management. i didnt get proper answer from them. lasty i contacted to TPA customer care, then they told that my wife hospital joining date is 4 days less than the date of endorsment with insurance company. But my management told me that they working on that to settle the claim. after few month later ie day before resigning . i got the mail from secondy party insurance company that claim is going to settle with one week. Now its been 6 weeks that my claim was not settled. what my question is endorsement delay is from my management side it is not my mistake. and they promised the benefits after prohibition was failed to give. pleasee suggest me that how do i approcah to get back my claim amount.

What exactly do you mean by :"i contacted to TPA customer care, then they told that my wife hospital joining date is 4 days less than the date of endorsment with insurance company."

Write to Management on it under proper acknowledgment.

 

This should be in your favor:"i got the mail from secondy party insurance company that claim is going to settle with one week. ".

Write to insurer to supply payment.

 

Kumar Doab (FIN)     12 May 2017

Don't give a very long rope and if payment is not made entrust to a very able counsel of unshakable repute and integrity at your location specializing in conusmer matters. 

Kumar Doab (FIN)     12 May 2017

If you are confident that you can handle on your own as PIP, go ahead and approach DCDRF.

The ACt, details, procedure , judgments are available at:

www.confonet.nic.in

Rama chary Rachakonda (Secunderabad/Highcourt practice watsapp no.9989324294 )     13 May 2017

The Insurance Ombudsman scheme was created by Government of India for individual policyholders to have their complaints settled out of the courts system in a cost-effective, efficient and impartial way.
There are 17 Insurance Ombudsman in different locations and you can approach the one having jurisdiction over the location of the insurance company office that you have a complaint against.
 
You can approach the Ombudsman with complaint if:

  • You have first approached your insurance company with the complaint and
    • They have not resolved it
    • Not resolved it to your satisfaction or
    • Not responded to it at all for 30 days
  • Your complaint pertains to any policy you have taken in your capacity as an individual and
  • The value of the claim including expenses claimed is not above Rs 20 lakh

Your complaint to the Ombudsman can be about:

  • Any partial or total repudiation of claims by an insurer
  • Any dispute about premium paid or payable in terms of the policy
  • Any dispute on the legal construction of the policies as far as it relates to claims
  • Delay in settlement of claims
  • Non-issue of any insurance document to you after you pay your premium
The settlement process

Kumar Doab (FIN)     13 May 2017

You can consider IO as well.

Enjapally vijay   13 May 2017

I claimed my insurance on nov-19

Dear Sir,

DOA is less than DOC, hence claim is not admissible.

From third party to second party, insurance company, third party & to my organisation

 

Vipul MedCorp Insurance TPA Private Limited

515,UDYOG VIHAR PHASE - V,

GURGAON (HARYANA) Pincode : 122 016

Phone :+91-124- 4833900 Fax :+91-124-4699611-12,4308211 Email :info@vipulmedcorp.com


Without Prejudice

 

To,

Divisional / Branch Manager
THE NEW INDIA ASSURANCE COMPANY LTD.
930000 - NIA, R.O LCO DELHI
301,R.G.CITY CENTER LSC,BLOCK B, LAWRENCE ROAD,NEW DELHI, PIN NO: 110035
NEW DELHI, DELHI
110019

Date: 25-Nov, 2016 
Query Letter No : 1QNIR1117031 
File No : 17RB01NIR0313 
Agent Code : Not Available
Dev

 

 

CASE HISTORY
ADMISSION DATE COULD NOT BE LESS THAN DATE OF COVERAGE

OBSERVATION

QUERY RAISED
ADMISSION DATE IS LESS THAN DATE OF COVERAGE

Thanking You,

 

 From my organization to second party

Dear Prakash Sir,

 

Ref to the trail mail received from VIPUL regarding Mrs.XXXXXXX claim, as informed you earlier and as per the data shared with you employee should covered from 01.08.2016. 

 

But the said employee was not covered under the policy as the endorsement was delayed. Ref to the discussions had with you a endorsement suppose to be passed on the coverage. 

 

Requesting you to confirm the status and do the needful on priority.

  Jan-23

From my organization to second party to third party

Dear Alliance Team,

 

What is the update on this...

 

Jan-23

From second party to my organization to third party

Dear Sir,

Sorry for delay reply...

We have been talking to claims head for issuing an endorsement with back dated

We will update you the same

 

From my organization to second party to third party                                                                                                    

Feb-3

Dear Sir,

 

Can we have the quick update on this...

                                                                                                           

 March-34

From my organization to second party to third party

Dear Sir,

 

As discussed last week still the claim was not processed and client wish to know the TAT. Requesting you to update us the status on priority. 

April-17

I got this mail the day when I resigned

From  to second party to my hr & me

Dear Anna babu garu,

As discussed, we are going to settle this claim in this week itself.

https://ssl.gstatic.com/ui/v1/icons/mail/images/cleardot.gif

 

Enjapally vijay   13 May 2017

Sir this reply is from 3rd party to me, my organisation and to insurance company

 

 

Dear Sir,

DOA is less than DOC, hence claim is not admissible.

From third party to second party, insurance company, third party & to my organisation

 

 

Vipul MedCorp Insurance TPA Private Limited

515,UDYOG VIHAR PHASE - V,

GURGAON (HARYANA) Pincode : 122 016

Phone :+91-124- 4833900 Fax :+91-124-4699611-12,4308211 Email :info@vipulmedcorp.com


Without Prejudice

 

To,

Divisional / Branch Manager
THE NEW INDIA ASSURANCE COMPANY LTD.
930000 - NIA, R.O LCO DELHI
301,R.G.CITY CENTER LSC,BLOCK B, LAWRENCE ROAD,NEW DELHI, PIN NO: 110035
NEW DELHI, DELHI
110019

Date: 25-Nov, 2016 
Query Letter No : 1QNIR1117031 
File No : 17RB01NIR0313 
Agent Code : Not Available
Dev

 

 

CASE HISTORY
ADMISSION DATE COULD NOT BE LESS THAN DATE OF COVERAGE

OBSERVATION

QUERY RAISED
ADMISSION DATE IS LESS THAN DATE OF COVERAGE

Thanking You,

 

Kumar Doab (FIN)     13 May 2017

You have posted that:

"From  to second party to my hr & me Dear Anna babu garu, As discussed, we are going to settle this claim in this week itself."

This is not for you!

Enjapally vijay   15 May 2017

 dear sir,

problem is with my hr , who is supporting our insurance manager, who is responisible for delayed our registration with insurance company. my registration is supposed to be with in 10th-aug-2016, due to insurance manager ignorance it was registered on 19th -aug-2016, plz help me out how to approach labour court to complain on my hr against their delaying.

 

Kumar Doab (FIN)     15 May 2017

Does company deduct premia from salary?

Is it reflected in salary slip?

Is it show in CTC?

Is there any communication in writing that coverage is from dated…………….

Find out from docs to fasten the responsibility on employer and its attorney’s in HR/Admin/Insurance manager.

Enjapally vijay   15 May 2017

 

IT is not shown in CTC,

benefits can be availed after proohibition period., so my prohibition was completed on 30-july-2016

management issued medi-claim cards, which is valid from 05-may-2016 to 04-may-2017, but our names were endorsed to insurance company ( prohibition period) after six months, with 19 days delay

Enjapally vijay   15 May 2017



DOA is less than DOC, hence claim is not admissible.

From third party to second party, insurance company, third party & to my organisation

 

 

Vipul MedCorp Insurance TPA Private Limited

515,UDYOG VIHAR PHASE - V,

GURGAON (HARYANA) Pincode : 122 016

Phone :+91-124- 4833900 Fax :+91-124-4699611-12,4308211 Email :info@vipulmedcorp.com


Without Prejudice

 

To,

Divisional / Branch Manager
THE NEW INDIA ASSURANCE COMPANY LTD.
930000 - NIA, R.O LCO DELHI
301,R.G.CITY CENTER LSC,BLOCK B, LAWRENCE ROAD,NEW DELHI, PIN NO: 110035
NEW DELHI, DELHI
110019

Date: 25-Nov, 2016 
Query Letter No : 1QNIR1117031 
File No : 17RB01NIR0313 
Agent Code : Not Available
Dev

 

 

CASE HISTORY
ADMISSION DATE COULD NOT BE LESS THAN DATE OF COVERAGE

OBSERVATION

QUERY RAISED
ADMISSION DATE IS LESS THAN DATE OF COVERAGE

Thanking You,

 

 From my organization to second party

Dear Prakash Sir,

 

Ref to the trail mail received from VIPUL regarding Mrs.XXXXXXX claim, as informed you earlier and as per the data shared with you employee should covered from 01.08.2016. 

 

But the said employee was not covered under the policy as the endorsement was delayed. Ref to the discussions had with you a endorsement suppose to be passed on the coverage. 

 

Requesting you to confirm the status and do the needful on priority.

 Jan-23

From my organization to second party to third party

Dear Alliance Team,

 

What is the update on this...

 

Jan-23

From second party to my organization to third party

 

Dear Sir,

Sorry for delay reply...

We have been talking to claims head for issuing an endorsement with back dated

We will update you the same

 

From my organization to second party to third party                                                                                                    

Feb-3

Dear Sir,

 

Can we have the quick update on this...

                                                                                                                      

 March-34

From my organization to second party to third party

Dear Sir,

 

As discussed last week still the claim was not processed and client wish to know the TAT. Requesting you to update us the status on priority. 

 

April-17

I got this mail the day when I resigned

From  to second party to my hr & me

Dear Anna babu garu,

 

As discussed, we are going to settle this claim in this week itself.

https://ssl.gstatic.com/ui/v1/icons/mail/images/cleardot.gif

Kumar Doab (FIN)     16 May 2017

Originally posted by : Enjapally vijay






DOA is less than DOC, hence claim is not admissible.

From third party to second party, insurance company, third party & to my organisation

 

 

Vipul MedCorp Insurance TPA Private Limited




515,UDYOG VIHAR PHASE - V,




GURGAON (HARYANA) Pincode : 122 016




Phone :+91-124- 4833900 Fax :+91-124-4699611-12,4308211 Email :info@vipulmedcorp.com










Without Prejudice




 




To,




Divisional / Branch Manager
THE NEW INDIA ASSURANCE COMPANY LTD.
930000 - NIA, R.O LCO DELHI
301,R.G.CITY CENTER LSC,BLOCK B, LAWRENCE ROAD,NEW DELHI, PIN NO: 110035
NEW DELHI, DELHI
110019


Date: 25-Nov, 2016 
Query Letter No : 1QNIR1117031 
File No : 17RB01NIR0313 
Agent Code : Not Available
Dev





 

 





CASE HISTORY
ADMISSION DATE COULD NOT BE LESS THAN DATE OF COVERAGE




OBSERVATION




QUERY RAISED
ADMISSION DATE IS LESS THAN DATE OF COVERAGE




Thanking You,





 

 From my organization to second party

Dear Prakash Sir,

 

Ref to the trail mail received from VIPUL regarding Mrs.XXXXXXX claim, as informed you earlier and as per the data shared with you employee should covered from 01.08.2016. 

 

But the said employee was not covered under the policy as the endorsement was delayed.
Ref to the discussions had with you a endorsement suppose to be passed on the coverage. 

 

Requesting you to confirm the status and do the needful on priority.

 Jan-23

From my organization to second party to third party

Dear Alliance Team,

 

What is the update on this...

 

Jan-23

From second party to my organization to third party

 

Dear Sir,

Sorry for delay reply...

We have been talking to claims head for issuing an endorsement with back dated

We will update you the same

 

From my organization to second party to third party                                                                                                    

Feb-3

Dear Sir,

 

Can we have the quick update on this...

                                                                                                                      

 March-34

From my organization to second party to third party

Dear Sir,

 

As discussed last week still the claim was not processed and client wish to know the TAT. Requesting you to update us the status on priority. 

 

April-17

I got this mail the day when I resigned

From  to second party to my hr & me

Dear Anna babu garu,

 

As discussed, we are going to settle this claim in this week itself.

 

 

 

The trail sent by you seems to be supporting you.

 

 

Kumar Doab (FIN)     16 May 2017

Originally posted by : Enjapally vijay
 

IT is not shown in CTC,

benefits can be availed after proohibition period., so my prohibition was completed on 30-july-2016

management issued medi-claim cards, which is valid from 05-may-2016 to 04-may-2017, but our names were endorsed to insurance company ( prohibition period) after six months, with 19 days delay

 

The info posted by you seems to be supporting you.


Leave a reply

Your are not logged in . Please login to post replies

Click here to Login / Register