Srinivas (AM - HR) 17 February 2009

Reg - Group Mediclaim 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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3 Replies

PALNITKAR V.V. (Lawyer) 17 February 2009

Better to approach the consumer forum. Denial of your claim amounts to deficiency in service and you will get the claim as well as compensation through the consumer forum. That is the quickest remedy if the negotiations do not work.

Srinivas (AM - HR) 19 February 2009

Dear sir,

Thanks for your reply.

Is there any procedure for the same.

Regards,

Srinivas

PALNITKAR V.V. (Lawyer) 19 February 2009

You have to file a simple complaint to the consumer forum stating all the facts in detail. Annex copy of the insurance documents, the copies relating to your claim including medical record and bills. Style yourself as Applicant and the insurance company as respondent. If possible consult some lawyer for drafting.