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I have been undergoing expensive chemotherapy treatment for my blood cancer. However, Medi-Assist India, TPA to New India is resoirting to delay / refusal tactics. I had submitted my claim on 14.03.2014 after prior intimation of making advance payment to Apollo. However, now they mention that floater policyu is not available and again Rs.2 Lakh annual cap is exhausted. Since it is an ongoing policy, they could have processed it in FY 2014-15 Policy Year. They also have not returned my paper even after 2.5 months; 30 days' limit for claim submission with my another Insurance compnay is also not possible. They are not responding to email. My 11 th chemo session has become due. I have lodged complaint with Insurance Ombudsman / Central Ministry but this is time consuming process. What else I can do. Please guide me.Best regards, Jayanta Bandyopadhyay/26.05.2014

 
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Legal Adviser

Dear Mr. Jayanta Bandyopadhya,

I have perused your query posted at the Forum of Lawyersclubindia, seeking thereby legal advise to take your further step in the matter of your Mediclaim Insurance Policy at the end of The New India Assurance Co. Ltd. at your end.

First of all, I wish and pray my Lord SAI for your earliest recovery from your ailment. Further through your instant message I observe the followings :-

a) You being an Insured at the end of said Insurer, have lodged your claim  on 14.03.2014 after prior intimation of making advance payment to Apollo at their end of TPA.

b) Medi Assist India is making delay / refusal tactics on your claim on the ground that floater Policy is not available and again Rs.2 Lakh annual cap is exhausted.

c) You are aggrieved by their (Insurer) above sayings, Since it is an ongoing policy, they could have processed it in FY 2014-15 Policy Year. They also have not returned your papers even after 2.5 months and hence you are even unable to submit your claim with your another Insurance company due to its time limitation of 30 days for lodgement of claim. And also they are not responding to your mails.

d) You have lodged a complaint at the end of Insurance OMBUDSMAN, also

For extending my appropriate legal advise, I would like to examine the relevant Policy, its prescribed terms/conditions as well relevant documents inclusive of your mail (s) as well copy of your complaint lodged with OMBUDSMAN AND hence you are advised to forward all these along with your brief complaint by generating it on www.powertoconsumer.in

Said website is extending its free service to all consumers and extend legal advise & assistance.

Please expedite the matter to enable me to help you in time. Thanks,

SHIVESH SINHA,

Advocate Cum Legal Adviser to www.powertoconsumer.in

 
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