1. The undersinged is having a continuous and uninterrupted floater mediclaim policy (having sum insured of Rs.1,00,000/-) GOLD PLAN bearing No.282510403449 valid till 31.03.2010 (with its two renewals, first year policy No.282520063028 and second year policy No.282550103210) with the Reliance General Insurance Co.Ltd. and M/s.Medi Assist India Pvt.Ltd., is the TPA in the said policy.
2. On 02.06.2009, when Mr.Vijay, the Insured, was got admitted in St.Stephen Hospital for his treatment as he got paralytic attack and was discharged on 14.06.2009.
3. Thereafter, on 23.06.2009, the Insured, lodged a claim of Rs.67,587/- (containing 64 pages) with the TPA with a request to expedite the same, which was registered at its Claim No.4201680 under its ID.No.4008464711. It is pertinent to mention herein that the said entire claim with originals are still with the TPA.
4. Thereafter the TPA vide its various letters raised certain quarries which were duly complied with by the Insured
5. During the pendency of the aforesaid claim, on 17.09.2009, the Insured, as per the policy of the Respondent No.2, lodged his Post Discharge Claim of Rs.35,301/- (containing 6 pages) with the TPA which was registered as its Claim No.4382312.
6. The Insured sent a notice dated 12.10.2009 to the TPA thereby claiming the settlement/clearance of the aforesaid claims. Thereafter, on 20.10.09, 23.10.09, 30.10.09, 06.11.09, 12.11.09 and 16.11.09, the Insured again sent its reminders, but they did not take care thereof.
7. Thereafter, the Insured repeatedly contacted the officials of the TPA (Rajinder and Abha) Rajinder, who represented himself to be the officer and the whole sole incharge of the said claims of the Insured started lingering on the clearance of the aforesaid claims with ulterior motives, despite having no other quarry in the claims. On 27.11.2009 (after a gape of 155 days of the claim) the said Rajinder telephonically demanded Rs.10,000/- from the Insured as illegal gratification for early clearance of the aforesaid two claims of the Insured, to which the Insured denied and flatly refused to pay the same as there was nothing wrong in the matter and the said culprit Rajinder was trying to misuse his power and position. The Insured, being the law abiding citizen, made a complaint to the Rel.Gen.Ins. of Rajinder who registered the same as Complaint No.769462 dated 27.11.2009 and assured the Insured to resolve the same within seven days.
8. On 09.12.2009, the Insured received a SMS from the TPA in which they denied the claim of the Insured and a written communication/letter thereof was received by the Insured on 28.12.2009, whereby the TPA repudiated the claim of the Insured on the pretext that, in short, the disease of paralytic attach is an old ailment and the Insured has not disclosed the same earlier.
9. Thereafter, finding no alternative, the Insured lodged a consumer complaint against them which is pending adjudication in Consumer Court.
On 02.03.2010, the undersigned made a request to the Reliance General Insurance Co.Ltd., which was registered with the said company as Request No.98041, to renew the policy of the Complainant as it is going to expire on 31.03.2010, but neither the Respondent No.2 taker care of such request nor any of its representative ever contacted the Complainant for the said purpose.
Thereafter, the undersigned made several complaints which were registered as Complaint No.1011502 dated 08.03.2010, thereafter same complaint number dated 13.03.2010, dated 20.03.2010 and again dated 24.03.2010, but the company did not take care of it.
Finally on 23.03.2010, the undersigned personally visited the company at its branch office in NOIDA and handed over a cheque bearing No.060399 dated 23.03.2010 amount blank alongwith a covering letter, to one Shri Ankur, official of the company who accepted the same, copy of the said acknowledgment is enclosed herewith for your kind perusal.
In the morning of 25.03.2010, said Mr.Ankur official of the company telephonically informed the undersigned that the system is not generating renewal demand and the company will not renew the policy as the matter is pending before court.
Sir, on one hand the company declined the claim of the claimant and on the other hand is not accepting the premium of policy of the claimant arbitrarily thereby causing wrongful loss to the claimant and his family for no fault of them.
In case appropriate order/direction is not passed against the Company, then the claimant shall suffer irreparably which cannot be compensated in terms of money.
You are, therefore, requested to look into the matter and direct the Company to accept the premium of the health policey of the claimant which is goint to expire on 31.03.2010 and futhter to take appropriate descilipiarny action againt the company and its officials for their illegal and arbitrary acts of denying to accept the premium of police.
I shall be highly oblige for your early response in the matter.