[Resolved]  Star Health And Allied Insurance Company Ltd Chennai — non refendable of medical reinbursement bill

From
A.Amirthanathan
(Retd) Assistant Executive Engineer
39/2 “SARO” , 4th Cross
Timber Depo Road
Nesamany Nagar
Nagercoil - 629001
Phone[protected], Cell -[protected]
E.[protected]@gmail.com

To
The Director
Consumer Council of India


Respected sir,

Sub: Medical Reimbursement payment of A.S.Ambish (Life member of
Human Rights Organization Member No.142675) from Star Health
Allied Insurance Company Ltd.- Delay in claim settlement – regarding:

Ref: My application July 2007 addressed to the National Human Rights
Organaisation Nagercoil.

I am a Consultant for Civil Engineering Construction in PSN Group Of Institutions Palayamcottai Taluk . I have insured myself and three of my family members in Star Health and Allied Insurance Company Ltd. Chennai (Phone[protected] –Toll free – [protected], Fax-2828886, E [protected]@starhealth.in) through their Branch Office at Thirunelveli (Phone No[protected] Vide (Policy No.C/TVL/900000/GMC/01/[protected]/00172).

My son A.S.Ambish was admitted in the Dr. Morris Mathias Hospital Nagercoil on 30.08.008 and discharged on 1.09.2008. I have informed the details of admission of the patient to the Insurance Company Head Office at Chennai and the Branch Office at Tirunelveli and received the claim No. 9489. The representative of the company visited the Hospital and collected the details from the patient and from the Hospital authorities.

I have sent the original bills and discharge summary of the investigation reports received from the hospital duly filled up their claim form for the reimbursement amount of Rs.5026/- (copies enclosed). I have requested the reimbursement amount so many times through E-mail, SMS and over phone to their Head Office at Chennai and to the Branch Office at Thirunelveli. Moreover, I have sent the requested details of the company (details of the Emails sent on the subject is enclosed.


I have been receiving a usual reply “The bills are under processing and investigation” for the last 6 months. After a period of 10 months from lodging the claim, the Insurance Company now ask me to submit the original investigation reports. I am unable to understand ‘What they are asking for.

It is the company responsibility to depute any responsible person to the Hospital to investigate and verify the details against the claim submitted by me. Further the original bill details were already submitted to the Insurance Company and other original details are kept at the Hospital for further treatment of the patient. The Company has already collected the details from the Hospital

By not responding properly against the claim and declining repeated attempts to contact the company it is very clear that they are trying to cheat the customers. I have already suffered payments in lieu of the insurance premium amount and suffered financially and mentally due to the continued neglect of the financial loss.

Considering the above details, it is submitted that priority actions may kindly be taken to order release the actual claim for Rs. 5026/- and damages for the mental and physical sufferings for the continued neglect of the claim.



Yours Faithfully,


A. Amirthanathan

Encloses :

From,
A.Amirthanathan
(Retd)Assistant Executive Engineer
39/2 SARO , 4th Cross Street,
Timber Depot road,
Nesamony Nagar,
Nagercoil -629001
Phone[protected] ,Cell-[protected]
[protected]@gmail.com

To,
National Human Rights Organaisation,
Nagercoil
Head office : 1st ,street,janakpuri,New Delhi.
138/1,Bigcar street,Thiruparankkundram,Madurai. Phone : 2485251
Cell No : [protected]
Sir,
Sub; Medical reimbursement payment of A.S.Ambish (Life member of Consumer Rights Organaisation Member No; 142675)-Star Health and Allied Insurance Company Ltd –Regarding;-
I am a Consultant of Civil Engineering construction works in PSN.Group of Institutions, Melathidiyoor , Palayamkottai Taluk. I have insured for myself and 3 of my family members in Star Health And Allied Insurance Company Ltd. Chennai (PhoneNo;[protected] – Toll Free-[protected], Fax-2828886 , E-mail –[protected]@star health .in ) through their Branch Office at Tirunelveli (Phone No. [protected].
My son A.S Ambish was admitted in the Dr.Moris Mathias Hospital Nagercoil on[protected] and discharged on[protected] . I have informed the present stage of the patient to the Head Office Chennai and Branch Office Tirunelveli and received the Claim No;9489 ( Policy No.C/TVL/900000/GMC/01/[protected]/00172) The representative of the company visited the Hospital and collected the details from the patient and from the Hospital authorities.
I have sent the original bills and discharge summary of the investigation reports as received from the hospital duly filled up their Claim form for the reimbursement amount of Rs.5026/- (copies enclosed)
I have requested the reimbursement amount so many times through E- mail , SMS, and phone messages to the Head office Channai and to the Branch office Tirunelveli (Phone No.o[protected]. .More over I have sent more details as requested by the company then and there (copies of E-mail enclosed) . The period of Insurance policy was one year from[protected] to[protected] and the date was expired on 16-6-09

I have received the usual reply ie “ The bills are under processing and under investigation “ for the last six months.
After ten months they have once again requested me the original investigation reports . I did not know what they are asking ?


It is the responsibility of the insurance company to depute their responsible person to the Hospital to investigate the details of the patient . The orginals are available at the Hospital for further treatment of the patient.
They are cheating the customers and the customers are suffering mentally , physically ,and financially . I am requesting that, these types o[censored]nnecessary activities should not be practiced hereafter.
Lot of customers are suffering much ,due to their unnecessary activities . Please instruct the company to avoid such type of unnecessary remarks during the payment of reimbursement amount.
Thanking You,

Nagercoil Yours faithfully
-07-2007

(A.Amirthanathan))