Sub : Denial of Claim due to “false charge” of Pre-existing disease for Policy No 272900/48/2013/12741 (I (Gurpreet Singh) writing this latter on the behalf of my Father Mr. Harpinder Singh) This is to highlight the gross poor service being provided by company (Mediassistindia)to an elderly person like me. I have been a faithful customer of this company form last two consecutive years and I have never faced any kind of problem so far except the one which took place in October 2013. Before I go ahead with my case history, following are the case details : 1. Name of the policy Holder : Mr. Harpinder Singh 2. Current Policy No : 272900 / 48/2013 / 12741 I have this policy from year 2012 and my previous policy no is 272900/48/2012/ 9178. I have been treated twice for different reasons in the “Jaipur Golden Hospital” and my entire cost was re-imbursed. However, when I was admitted in the same hospital in Oct 2013, my cashless option was not provided to me by TPA as the policy plan. I was told that I can continue with my medication and best possible would be done from the company side. I underwent the medication as suggested by Hospital and when I approached my TPA “ MediAssist”, I was not giving clear cut answers. After lengthy follow up, I got to know that my claim has been denied. When I asked for the reason, I was told bluntly that it was done due to “Sugar” problem which as per them is pre-existing disease(Till date nothing has been reach to me in written). I am an old man but I never had the problem of “Sugar” at all & I have offered them to come and examine any time or the doctor statement can be shared. You can refer to all my previous claims from insurance, there is nowhere mention of “Sugar” history at all. I never had “Sugar”, nor do I have now for the confirmation I have enclosed the latest report with this mail. This is clear cut violation of customer’s right by TPA. I request you to kindly go through the entire claim request and check the documents carefully and re-imbrues my bills of approx. 2 Lakh which have caused me a lot of hardship despite being a genuine policy holder.

Full Billed Money (approx. 2.25 lakh) + 65000 which I have paid as interest on the loan amt + 3 lakh for the mantel harassment, which Me, my wife, my parents & my nearest has to go through. as well as for the in numerous follow-up’s which I am doing with the TPA Mede assist India, oriental Insurance Company & IRDA who is regulatory authority.

Complainant Information
name- gskatyal