Dear Sir/ Madam,

Awaiting your response.
Please revert.. its urgent.

Regards,
Reena Agarwal

——————————————————————————–
From: reenaagarwal@hotmail.com
To: apurbahazra@orientalinsurance.co.in; complaints@irda.gov.in; hironmoy.mukhopadhyay@orientalinsurance.co.in; jkkapoor@rediffmail.com; debjani.ray@medicaretpa.co.in
Subject: Complaint against the Oriental Insurance Co. Ltd
Date: Sun, 25 Jul 2010 22:48:20 +0530

From: Reena Agarwal

2 F, Abinash Niketan

22A Gora Chand Road

Kolkata – 700014

Date: 24th of July 2010

Grievance Call Centre

Insurance Regulatory and Development Authority

Crystal Palace, fortune Select Manohar,

Begumpet Airport Exit Road, Begumpet.

Hyderabad

Dear Sir,

Sub: Complaint against the Oriental Insurance Co. Ltd.

Divisional Office No. 5, Kolkata

I am a cancer patient with sigmoid colon and liver metastasis. It was diagnosed on 15.06.2009 as per FNAC report. At that time I was covered under:

Family Health Insurance policy of my son Tusar Agarwal with ICICI Lombard General Insurance Co (P) Ltd. Card no. ILGIC/ICB/000014648 valid from 01.01.2009 to 31.012.2009 for the sum insured of Rs. 4 lakhs, and another

Happy Family Floater Insurance policy (Silver Plan) issued to my son Tusar Agarwal as primary member by the Oriental Insurance Co. Ltd, Division 5 bearing policy no. 311500/48/2009/6039 valid from 18.03.2009 to 17.03.2010 for the sum insured of Rs. 5 lakhs, subject to 10% co-pay (cashless).

During my treatment, I have gone through harshest and aggressive chemotherapies of 51 hours duration at the interval of 2 weeks each. The entire Hospital bill of the medicinal treatment of Rs. 4 lakhs was taken care of by ICICI Lombard General Insurance Co. (P) Ltd.

The second phase was Surgery, which was done in Lilavati Hospital & Research Centre, Mumbai by Dr. P. Jagannath, Chairman of Oncology Surgeon and his team. I had been in hospital for 15 days since 12.10.2009 to 27.10.2009. My insurance coffer of ICICI Lombard General Insurance Co (P) Ltd exhausted, showing nil balance.

I wished to utilize my another lifeline – Happy Family Floater Insurance policy but alas! Medicare TPA was not in the network of Lilavati Hospital. Hospital bill rose to Rs. 8,20,188/- apart from Dr. P. Jagannath’s bill and bill for PET CT Scan. Anyhow members of my family managed the finance and paid the bills.

I lodged the claim no. 11091828 with the TPA of the Oriental Insurance Co. Ltd. – M/s. Medicare TPA Services (I) Pvt. Ltd., Kolkata on 04.11.2009 with all the supporting documents of Lilavati Hospital, in the hope that I shall get the cheque in a fortnight or latest within a month.

I got Claim Repudiation letter dated 12.11.2009 from Medicare TPA Services (I) Pvt. Ltd. signed by Dr. Ananya Moitra. The claim was repudiated on the ground that it was a pre- existing disease, as because the policy under which the claim was lodged was taken on 18.03.2009 and the cancer was diagnosed on 15.06.2009, within a short period of three months of taking policy. In this context, one vital aspect they have ignored is that my insurance is in continuation of my erstwhile Individual Mediclaim policy no. 311500/48/2009/4421 dated 01.01.2009.

I went through the policy clause very minutely and nowhere any time – limit is mentioned between taking policy and the contacting disease like cancer. It means the claim for cancer is admissible from day one of taking policy. It is criminal case of breach of contract to suspend the issue for such a long period.

I am waiting for the redressal of my grievance for the last nine months. I have written six letters to the Divisional Manager, with copies to Customer Care Cell of Kolkata Regional as well as Delhi Head Office, but no response from any corner.

Their ‘we-do-not-care’ attitude forced me to approach to you for getting my grievance redressed through your sincere efforts. You are requested to register my complaint and inform me of the development of the case, avoiding further delay.

Thanking you,

Truly Yours,

Reena Agarwal.