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.

Sir,
I had purchased a Cell phone in 25th march 2010 from Univercell. When I purchased, they told me about the mobile damage/theft insurance , I paid additional 112.50 as the premium of the New phone.

Unfortunatelly, I lost the phone in canteen. I tried to trace it but could not find it. I filed a compliant with Police and letter went to Univercel for claiming the Insurance.
I filled in a Form and attach all the docs like purchase recipt, police compliant copy, Non tracable copy etc... in ORIGINAL and send it to ALEgION Insurance Broking Ltd in Chennai. So, I had no choice than to send it to them through a corrier. After attaching all the documents I got back the corrier from the Insurance comp twice asking for more info insufficiany of documents. They had given some phone numbers to contant which rings for ever and no one answers. however, I do get a engage/busy message at some time for these numbers but they never pick up my calls.....

This ALEgION Insurance Broking Ltd is just making money form the customers but not responding nor issuing the insurance.

Please kindly let me know what needs to be done. Please do as early as possible.

NARESH PAUL
9739342519

Subject: Insurance Policy No. 231300/31/2010/1273 in pursuance of
Cover Note No. CHD-C 686781 Dated 29.04.2009 Vehicle No.
HR-04B-1414 Tata Safari Model 2009.

Sir,
The above-mentioned cover note and insurance policy was issued by the Oriental Insurance Company valid upto 28.04.2010 after charging the amount in cash. The vehicle was stolen by some body on 17.02.2010 from House No. 3190, Sector-21 D, Chandigarh and the FIR no. 30 u/s 379 IPC dated 17.02.2010 PS Sector –19 Chandigarh was lodged and the company was duly informed vide application and telegram and personally.
In pursuance of the Telegram and the application, the company deputed investigator and the investigator under the name of Royal Associates (Investigating and Detective Agency) started their Investigation in the month of March, 2010 and continued visiting the house of the applicant and the house of my friend i.e. Satraj Singh Toor R/o H. NO. 3190, Sector-21 D, Chandigarh from where the vehicle was stolen. The investigator recorded the statements of the applicant and the neighbourers twice and the statements of my friend Satraj Singh Toor and his neighbourers and asked to submit the various documents including the original D/L, Ration Card, Voter Card and the Untraceable Certificate from the Police and the Original Insurance Policy. The various letters of investigating agency can be produced if required, however, one of the letter of the investigating agency and the copy of the FIR, Untraceable Report and the copy of the Cover Note are being sent along the copy of the application for perusal.
To the utter surprise of the applicant the insurance company vide their letter dated 26.05.2010 informed the applicant that since the premium cheque no. 294899 dated 29.04.2009 for Rs. 22318/- drawn on State Bank of Patiala towards Premium stands Dishonoured with the Remarks Insufficient Funds, hence the office has decided to close your file as “No Claim”.
It is pertinent to mention here that the vehicle was purchased in the late night on 29.04.2009 and instead of cash a cheque was handed over against the Cover Note with the assurance that in the morning the agent will receive cash and return the cheque. The agent received the cash from the applicant on the next day, but did not return the cheque. The applicant received the insurance policy duly signed and issued by the authority which was valid up to 28.04.2010 and informed the authorities about the theft of the vehicle on 17.02.2010, but surprisingly the company informed the applicant on 26.05.2010 after completing the entire and lengthy process of investigation about the closing of the file as “No Claim” without affording any opportunity of hearing or giving show cause notice to explain as to why the policy remained valid till 26.05.2010 and the Company failed to inform the policy holder about the ineffective and Invalid Policy.
In this regard it is submitted that the Hon’ble Supreme Court of India in a case titled as National Insurance Company Ltd. versus Abhay Sing, Partap Sing Waghela and Others 2008(4) RCR (Civil) 173: “Insurance of Truck – Premium paid by cheque – Insurance company issuing insurance cover- dishonour of cheque – truck causing accident – premium paid in cash after accident – insurance policy liable to third party – insurance cover remains valid till it is cancelled”.
In the present case the insurance policy remained valid till the theft of the vehicle and filing of the claim, conducting of the investigation and submission of final report along with the entire documents till 26.05.2010 and the insurance company cannot take this stand at this movement.
The hard earned money of a retired soldier who has sacrificed his entire life to the nation and his two sons are still serving the nation as Lt. Col. and Major respectively and the vehicle was purchased by the applicant after borrowing the money from the friends and relatives, the claim of which is being denied by the insurance company.
It is humbly submitted that the matter be taken up and after going through the entire facts the directions may be issued to the insurance company to pay the claim of the vehicle against the Policy issued by the Insurance Company remained valid till 26.05.2010 to give honour to a Retired Army Officer.
Thanks in advance for kind hearing.
Sincerely,

Chandigarh Lt. Col. S R Gogar (Retd.)
R/o H. No. 662, Sector-12 Dated: 30.08.2010 Panchkula
Contact: 0172-2577366
Mb: 9216080762