May 24, 2016 05:56 AM
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National Insurance Division Xi at 19 R N Mukherjee Road, Ground Floor, Kolkata is giving
Worst Customer Service to the Policy Holders of the Mediclaim Policies. The Mediclaim Claim which was already settled by there TPA, Genins India TPA Ltd. in the Month of March 2016 inspite of that the Policy Holders are still waiting for to get the Claim Amount credited in to there Bank Account.When the Policy Holders are contacting the TPA over the Phone they were informed by the TPA they your Claim already settled from our end and its pending from the National Insurance end to credit the Claim Amount in to your Bank Account and even in the Policies where Death of Policy Holder known to National Insurance as they have already paid the claim on Cashless Basis only Pre & Post Hospitalisation Expenses they have to pay and the Claim file already processed and setteled by there TPA as No documentation left from the Clients end again the claim amount is not credited in to the Bank Account of there Nominee. The Policy Holders are suffering because National Insurance Division XI has taken them as an granted .In this regard also note.that In the Current National Mediclaim Policy Condition in the Page No. 6 in the last paragraph its mentioned there that they will pay the interest to the Policy Holder in the case of delay in the payment of the Mediclaim Claim amount to them.Kindly take a look below what mentioned in there Policy Condition
5.3.5 Claim Settlement
i. On receipt of the final document(s) or investigation report(if any), as the case may be, the company shall within a period of 30 days offer a settlement of the claim to the insured person.
ii. If the company, for any reasons, decides to reject a claim under the policy, shall communicate to the insured person in writing and within a period of 30 days from the receipt of the final document(s) or investigation report(if any), as the case may be.
iii. Upon acceptance of an offer of settlement as stated above by the insured person, the payment of the amount due shall bemade within 7 days from the date of acceptance of the offer by the company.
iv. In the cases of delay in the payment, the company shall pay interest at a rate which is 2% above the bank rate prevalent at the beginning of the financial year in which the claim is reviewed.
Every Policy Holder whose Claim Amount is not credited in to there Bank Account because of the Negligence of Service of National Insurance must write a letter to the National Insurance Division Xi with a copy to there Regional Office, Head Office, Grievance Cell and also to the IRDA and Claim Interest from them
