J.A.C. Vincent,
B.Com (Hons), DBM, MMS.,
“GAJ-GAURI” – Ist Floor, 30/A, Tatya Tope Soc.,Wanawadi, Pune – 411037.
Cel: 9823263428
Feb 6, 2010

Shri R.K. Vashistha, Insurance Ombudsman, Email & Copy by Post
Office of the Insurance Ombudsman,
Email:ombudsman@vsnl.net
Jeevan Seva Annexe III Floor, S.V.Road, Santacruz (W), MUMBAI-400 054

Dear Sirs,

Sub: Procedure for Reimbursement Services. – Mediclaim Policies of National Insurance Co. Ltd.
Ref: Policyholder’s Guide Book issued by TPA MDIndia Healthcare Services (TPA) Pvt. Ltd.

I have just received the ID Card along with Policyholder’s Guide Book issued by TPA MDIndia Healthcare Services (TPA) Pvt. Ltd. Pune.

I find the Guide Book contains a very ridiculous clause in page no.8 regarding documents to be attached to the Claim Form which is reproduced below:-

“Clause No.iii. (Page No.8) – Photocopy of policy schedule (and all previous policies, in case of continuous coverage).”

This appears to be a new clause introduced by the TPA to harass further a hapless client of the National Insurance Co. as it will be a tool to reject the claim if photocopies of all previous policies, in case of continuous coverage, are not attached. To my knowledge such a bizarre clause was not there ever-before!

When a policy ends on the expiry date and a new Policy document is issued on renewal, the old policy document becomes just an useless paper and I don’t think anyone keeps it as a ‘historically treasured document’ for any length of time e.g. 20/30 years, as is the case with me in respect of the documents of mine and my family members. I discard the old documents as soon as renewal is done and new document is received instead of accumulating junk. How can the Company expect clients to maintain a record of a paper which becomes obsolete on expiry as the new documents contain details of claims/no-claim bonus amounts etc.. Where do I go to get the destroyed documents in case I have to prefer a Claim for Reimbursement?!

Is not the onus of maintaining its records in shape is on the Insurance Company for verification etc. and I am sure it cannot pass on its statutory responsibility to the clients to provide ancient records. This proves the popular joke cracked by those in the Private Sector and by the general public that whenever they approach the Government agencies for some requirement, such agencies always ask for copy of their own communication to be sent along with such requests made to them! With the era of automation and computerization, I am sure it is not difficult for the Company to maintain records in proper shape.

I therefore request you to kindly take up the matter with the concerned Insurance Companies and do the needful to do away with such obnoxious and irrelevant conditions which I say again will become a tool in their hands to reject any claim if photocopies of all previous policies, in case of continuous coverage, are not attached. I don’t think any of the Private Insurance Companies will opt for such trick!!

In their Preamble in their Guide Book TPA MDIndia says “We, the MDIndians, look forward to a long-lasting relationship with you. It will be our constant endeavor to provide all services to you with high quality and minimum turnaround time”….. This seems to be a farce with the new condition introduced as mentioned above.

Your immediate and practical solution will be appreciated.

Kindly acknowledge receipt. Yours truly,

J.A.C.Vincent

Copy to: IRDA for consideration and necessary action as suggested above.