Sep 01, 2011 11:11 AM
26059 Views
My name is Sujata Dilip Chakrbaorty. I stay in Thane Dist.. My late husband Mr.Dilip Chakraborty took a Mediclaim Policy from The New India Assurance Company Limited in 10/12/2007. But in the third week of Dec.2007 when we were visiting a temple, he suddenly became unconscious for a few seconds. We consulted specialist and the doctor prescribed him with some medications and one among them was an Anti-hypertensive drug, which he continued till March 2008 as per the doctor's advice.
He was completely fine. Then suddenly in 1/8/2010 he again fell unconscious and we rushed him to a local hospital. They referred him to Dr.Balabhai Nanavati Hospital, Ville Parle, Mumbai and we did accordingly. During the time of admitting him in the Nanavati Hospital, I told the Temple incident to the hospital staff and said them not to worry and he would be fine like before and I was confident that nothing can happen to him. He was the SUN for me. But unfortunately he went into coma and after being such a state for ten days.....on the morning of 11th August, 2010, he took his final spiritual journey leaving me in the mid-sea all alone.
Since I had already paid around two lakh rupees in the treatment, I called our Insurance Agent for reimbursement. After that as per our insurance agent's advice, I collected every piece of paper from the hospital and gave it to him for the claim purpose on 7/9/2010. The name of the agent is Mr.Arvind Simalkar, DEVELOPMENT OFFICER, The New India Assurance Company Limited, D.O. 110600, 9th Floor, NEW INDIA CENTRE. 17/A, Co-operage Road, Mumbai-400039.Mobile: 9821031889/9321131889.Res:26764747/4848. Fax:22829250.
Mr. Arvind assured me that by fifteen days, he would send my cheque to my address. After one month, he called me up and said I've to provide more details like Assignee name on Rs100/ Stamp Paper, and some more medical documents. I did accordingly in Oct.2010. In the next month, he sent me another letter asking for another medical certificate as well as a cheque for the continuation of my Mediclaim Policy. I sent those documents and the cheque ASAP to him in Nov.2010.
No reply came from his side. I used to call him and he did not respond. Finally, he took my call on January this year and asked me to see the Raksha TPA's website rather than calling him as he has many such clients to serve and he didn't like those disturbances. So, I went through the Raksha TPA's website and what I found was not less than a bullet from a heavy machinegun. For your reference purpose, I am giving the details in the following:-
"We have received your claim documents. As per documents available, patient was admitted in hospital on 01/08/2010 with the complaints of SEPTICEMIC SHOCK WITH INTERNAL BLEED. As per the copy of indoor case papers provided, patient is a known case of hypertension since 2007 with history of CVA recovered in 2007. Patient's date of issuence of first policy is 10/12/2007. That means hypertension is a pre existing the inception of policy and current ailement is result of hypertension. As per policy terms and conditions, pre existing ailments are not payable for four consecutive years. In this case, policy is in its 3rd year at the time of hospitalisation. Hecne, this claim stands repudiation under clause 4.1.
Clasue 4.1:- Pre-existing diseases/condition: All diseases/injuries/conditions, which are pre-existing when the cover incepts for the first time (except as shown hereunder). Any complication arising from pre-existing disease/ailment/injury will be considered as a part of pre-existing condition. This exclusion will be deleted after four consecutive claim free policy year provided there was no hospitalization for the pre-existing disease/ailment/condition/injury during the said four years of insurance with our Company. SEPTICEMIC SHOCK WITH INTERNAL BLEED WITH K/C/O HTN AND CVA IN 2007."
Shocked, I again contacted Mr.Arvind and he gave me one Mr.Srinivas'cell number who is from the Raksha TPA. I called Mr.Srinivas and he advised me to send a letter to their office asking for reconsideration of the decision.
In 4/2/2011, I sent a letter accordingly both to the Raksha TPA and Mr.Arvind Simalkar, DEVELOPMENT OFFICER, The New India Assurance Company Limited, D.O. 110600.
After that whenever I tried to call Mr.Arvind, he always disconnected my call. On 31st March 2011, I got a letter from the Raksha TPA, which was more than a machine gun bullet. They had rejected my reconsideration letter and the reason shown behind this decision was that ACCORDING TO THEM MR.DILIP CHAKRABORTY WAS ADMITTED FOR SEPTICEMIC SHOCK WITH INTERNAL BLEED WITH K/C/O HTN AND CVA IN 2007 IN Dr.Balabhai Nanavati Hospital, Ville Parle, Mumbai.
Finally on 15/4/2011, I sent a letter to both the Raksha TPA as well as Mr.Arvind and I just wrote that since they had the information that Late Dilip was admitted in Nanavati Hospital in 2007, it was their duty to prove it. It was a big joke on their part to reject my claim.
This was Late Dilip's first admission and unfortunately the final discharge from this planet earth.
I even requested them to settle my claim by one month of receiving the letter else they will have to face the music.
Next, you may think what happened to the cheque I sent for my policy renewal. Yes, I got my policy papers in June 2011 though I paid in Nov.2010 and if anything untoward would have been happened with me. Who would have been responsible?
A person died suddenly at the age of 42, leaving his grieving wife to battle for the rest of her life all alone, can't our own people be sympathetic and judicious? Can we call them HUMAN BEINGS??? No way.
To cheat me, they had taken all dishonest paths. They asked for Assignee's name on Rs.100/ Stamp Paper but my name is clearly written in each and every policy paper. It was a family policy and I was the other person included in the policy. IS IT NOT A dirty JOKE PLAYED ON A POOR WIDOW?
I don't know how many people have been cheated by these people?
One year gone. So I request please act timely so that I get my justice. JUSTICE DELAYED IS JUSTICE DENIED....In my case both happened.
A young lady living a hellish life for the last one year, does she deserve this? Where is our Government and their servants?
Please do something. We should get rid of these type of unprofessional dishonest people.
Thanks.
Sujata Dilip Chakraborty
You can mail me at sujatadilipchakraborty@gmail.com
