Complaint Details

Status	:	Closed
Complaint No	:	0030631/2014
Category	:	Insurance
Date	:	09-07-2014
Subject Line	:	Cheating/Fraud/Harassment by BSLI and TPA MD India
Complainant	:	Raju Padmanabhan
Address	:	B-406, 4th Floor, Bld No 16, Shastri Nagar , Goregaon (W),
Complainee	:	Birla Sun Life Insurance
Address	:	NA

Complaint Details
My father has taken this policy with Hospital care Rider of 1.5 lac and Critical care Rider of 1 lac. My father was hospitalized on 3rd May 2014 and discharged on 9th May 2014. We asked for cashless and the TPA informed us that please go through the reimbursement process. Hence we made the payment and then submitted documents for claim. On 15th May 2014 we submitted the claim documents with BSLI office in Andheri for an amount of Rs.1,02,028/-, the TPD then sent a query asking for my fathers operation details done in 2012 where there was no claim settled. we submitted the documents then they again asked for first consultation report for my fathers hospitalization. Which we didn't have and only letter from local physician asking him to be admitted immediately. Later after much of hassle I got letter from the Treating doctor and then MD india approved a claim of Rs.3600/- on 3rd July 2014. The Insurance company has cheated us in giving us Hospital care Rider of Rs.1,50,000/- and give us claim of Rs.3600/- as per their calculation. It is a clear case of fraud and cheating to the customer. Also the TPA MD India deliberately made the customer run around for 2 months only to settle claim of Rs.3600/-. I need the claim amount to be settled by BSLI and penalties to be levied to both BSLI and MD India for fraud / cheating and Harassment.

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