Srinivas (AM - HR) 19 February 2009

Reg - Group Medi claim Insurance

Hi all,

I am Srinivas working with a organisation in Chennai. As part of employment, all of us are having Mediclaim Group Insurance enrolled with a well-known insurance service provider.

As part of insurance cover, maternity benefit is also included. I incurred around Rs. 36000 during our child birth and submitted maternity benefit claim forms with all the original bills in Oct-Nov 08 to the Third party service provider (TPA). As per their notification to the company, they have said we can claim upto Rs.30000 for maternity benefit. Based on the above, pls clarify me the following

1. There was a huge delay of 4 months to process my claim and suddenly i have been informed that my claim has been rejected. But, vendor is saying that he will talk to underwriter and get it done. Moreover, i am already paying interest for the loan i took for the same, with this delay i lost hope on them. What is the remidy for this?

2. I would like to take this seriously because they wasted so much of time and put me in severe hardship. I want the market to know about their poor service. What shall i do to claim damages?

3. Is there really anyway to get my claim?

Please clarify me.

Thanks in advance.

Regards,

Srinivas

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2 Replies

M. PIRAVI PERUMAL (Advocate & Consumer Rights) 19 February 2009

You can approach the Consumer Court (DCDRF) challenging the repudiation of your claim. You can also claim compensation for mental agony. Please go through the policy terms and conditions and in particular the exception columns and also co-relate it with the reason cited by the Company for repudiation of you claim. Most of the mediclaim policy does not cover maternity and further more there will be a clause that the policy will not cover in case of pre-existing disease. Most of claims will be repudiated by these Company sstating the claim made is relating to pre-existing clause. The sole reason for failure of mediclaim policy is that even genuine claim are repudiated by the insurance companies.

Myself being a consumer rights' activist, if you deed any more details you can contact me at : piraviperumallaw@yahoo.co.in

Srinivas (AM - HR) 19 February 2009

Dear sir,

Thanks for your reply.

Actually, our policy does cover maternity benefit as we are paying top-up premium for that. We already have cases who have claimed it in the past.

But, onething that is worrying me is, now, insurance company is dragging it for 3 and half months and saying my claim is rejected and require time to give the reason.

May i request you contact number for any help on this.

Regards,

Srinivas