Jain International Organisation [JIO] — My claim is not prococessed jiojac [protected]

Http://www.jiojac.com/HELP

Respected,

With reference to above subject writing this email on behalf of Senior citizen Mrs. Rekha Shevantilal Shah (Age 73) for availing justice. Following are facts for your consideration and necessary action :

Mrs. Rekha Shevantilal Shah is group policy holder under Master policy holder Jain International Organisation since October 2016.Mrs. Rekha Shevantilal Shah (She) is renewing this group insurance policy regularly for all family members.She has taken Super Top Policy since 2018 of 10 lac with 5 lac deductible.Her[protected] renewed master policy number is 839/61175480/00/000 (Policy Document is attached for your reference)Her[protected] renewed Certificate number is 61175480/13715 Risk Commencement date 01/04/2020 Risk End Date : 31/03/2021.Her[protected] renewed master policy number is 2816/59774327/00/000 (Policy Document is attached for your reference)Her[protected] renewed policy Certificate number is [protected]/04578Risk Commencement date :01/04/2019Risk End date : 31/03/2019.

Claim Status about Cataract Operation for Mrs. Rekha Shevantilal Shah :

First correspondence done on 08 March, 2021 from email [protected]@gmail.com to [protected]@ericsontpa.com with cc to [protected]@ericsontpa.com for understanding eligibility of Cataract operation.Reply came only from 6 [protected]@ericsontpa.com on March 09, 2021 at 11.07 AM which was confirming eligibility of Rs.25000. (Actually mail was written to [protected]@ericson.comThere was no reply from [protected]@ericsontpa.com and this is the place where they created a miss direction to client Mrs. Rekha Shah.Client sent Thank you for confirmation mail on 11 March at 08.06 PM to [protected]@ericsontpa.com even though [protected]@ericsontpa.com was in cc and this is how Ericson TPA miss lead client Mrs. Rekha Shah.On March 17 at 10.55 AM one more mail was sent to 6saal mail id for knowing documentation process for cataract operation claim.6saal replied to this mail with list of required documents for processing claim and this reply came on March 17, 2021 at 11.45 AMOne more query done by client Mrs. Rekha Shah on March 22, 2021 to [protected]@ericsontpa.com about one more policy of 10 Lac which she is having. This time mail was sent only to 6saal mail id as she was receiving reply only from this mail id.She again got reply from 6saal mail id confirming eligibility of Rs.25000 for cataract operation on March 22, 2021.On March 24, 2021 at 1220 PM intimation email was sent to [protected]@ericson.com with subject line "Claim intimation of JioJac i'd [protected] with 2 attachment of documents.Operation was scheduled on March 25, 2021.On March 24, 2021 at 12.25 PM same claim intimation was sent to jio.[protected]@edelweissfin.comOn March 24, 2021 at 12.26 PM reply came from jio.[protected]@edelweissfin.com with confirmation of intimation and ticket number 1435337On March 25, 2021 at 1007 AM one mare email sent to [protected]@ericsontpa.com for getting claim intimation number.On 26 March, 2021 at 0157 PM mail sent to [protected]@ericsontpa.com about claim documents sent to their address through courier as per requirement.On April 01, 2021 at 0115 PM followup mail was sent on [protected]@ericsontpa.com to check claim paper status sent through courier. There was no reply from Ericson TPA.On April 02, 2021 at 0223 PM one more followup sent to check receipt of the courier which was carrying claim documents but there was no revert on this from Ericson TPA.On April 07, 2021 at 1230 Edelweissfin.com team members came into picture and received mail which was marked to [protected]@ericsontpa.com with cc to Mrs. Rekha Shah.On April 07, 2021 at 0251 PM there was reply from [protected]@ericsontpa.com (Which was not in picture at all) to jio.[protected]@edeweissfin.com with Cc to Client Mrs. Rekha Shah stating Claim intimation number 132506.On April 07, 2021 at 11.16 PM mail sent by Client Mrs. Rekha Shah asking confirmation of receipt of claim documents by reply to all mail to 6saal and edelweissfin.On April 07, 2021 at 11.20 PM there was automated acknowledgement mail from edelweissfin.comOn April 08, 2021 at 12.02 PM mail came from 6saal asking courier details to confirm receipt of claim documents.On April 08, 2021 at 02.10 PM mail sent by client Mrs. Rekha Shah stating that she spoke to customer care and they confirm receipt of documents. (It is surprising to note inhouse people are not aware)On April 08, 2021 at 02.15 PM received automated acknowledgement mail from edelweissfin.comOn April 08, 2021 at 05.16 PM mail came from 6saal to client as well as edelweissfin asking once again about courier details which is surprising as there was mail sent by client at 02.10 PM stating confirmation from customer care about courier. (Once again showing lithaginess of 6saal team)On April 08, 2021 at 10.17 PM Client sent reply to mail with courier receipt to avoid further arguments.On April 09, 2021 at 1246 PM mail received from 6saal stating attachment is not opening.On April 09, 2021 at 03.42 PM again mail sent by client to 6saal with attachment of courier receipt with cc to edelweissfinOn April 09, 2021 at 0540 PM mail came from 6saal with the same remark that attachment is not opening.On April 09, 2021 at 0718 PM replied by client with attachment in JPG format which was receipt of courier.On April 10, 2021 at 1136 AM mail received from 6saal stating that claim documents not received.(Surprising is Customer care is saying courier received)On April 10, 2021 at 01.29 PM client sent an email with attachment of courier acknowledgement which was showing courier reached on 27 April, 2021. (Total mismanagement by EricsonTPA. Very irresponsible behaviour).On April 10, 2021 at 0404 PM mail came from 6saal confirming receipt of claim documents as there was no scope to lie now because proof was sent by client.On April 14, 2021 at 0352 PM once again client sent Pan card, Aadhar card and 2021 policy documents as per demand by claim department.On April 14, 2021 at 0540 PM email from 6saal demanding documents in PDF. Last time they demanded JPG.On April 14, 2021 at 0836 PM client sent email of all documents once again in PDF file.On April 15, 2021 at 1137 AM mail from 6 saal gave confirmation of all documents and forwarded to concern people.On April 16, 2021 at 0544 PM again mail came demanding different policy details than what we claimed as well as same documents demanded which was sent to them on mail one day before.On April 16 at 0937 PM client sent all documents once again with all Health Card of current as well as past policies.On April 19 at 1231 PM email received from 6saal stating claim is under process.On April 20 at 0520 PM email came from 6saal demanding to share all documents in single PDF format. Client is a senior citizen and not tech savvy but took help and sent all documents again.On April 20 at 0724 PM client sent mail to 6saal where she mentioned about repeated demand of same or different documents but not settling claim even after one month. in this case she will approach IRDA for justice.April 21 at 1130 AM once again email from 6saal demanding one PDF of all documents which was really very disappointing.April 21 at 1143 AM client again sent all documents in PDF.April 23 at 0123 PM followup mail sent to 6saal to know status of claim by Client.April 26 at 0139 PM one more followup mail sent to 6saal for claim settlement April 29 at 1016 AM client sent mail to 6saal for checking claim status. All the time edelweissfin was in cc.April 29 at 1035 email of claim rejection sent by 6saal with reason that Cataract operation is not covered in first year of policy. (Actually policy has continued for the last 5 years)April 30 at 1010 PM email sent by client to 6saal that this claim is registered under base policy which has been running for the last 5 years and not super top policy.Again and again correspondence is done to 6saal, edelweissfin but they are not processing the claim so finally we are writing all the above facts to get justice.

Some of our observations :

Claim process is given by edelweissfin and we followed the same by client but they tried to create confusion by sending email through different mail id like [protected]@erisontpa.com ; jio.[protected]@edelweissfin.com and [protected]@ericsontpa.comClaim was registered under base policy but they are trying to show under Super Top Policy.It seems to be intent of rejecting genine claim by misleading client as well as JIO JAC organisation.This looks like a case of fraud by Broker as well as company.

Sincere Request :

Strict action and punishment need to be done for all involved with life time lessons so that customers should not suffer.Our claim with penalty of mental harassment of senior citizens to be charged to all responsible parties.