Awards & Judgments

OMBUDSMEN

I am very glad, at least some of the arms created by the Government through legislation are working satisfactorily.

This is my experience with the Insurance Ombudsman, Hyderabad :

I have purchased a health Insurance Policy from "MAX BUPA" health insurance company and the policy is in force. 

Unfortunately, I was hospitalised for irregular heart beat, and took treatment at Varma Hospitals, Bhimavaram, incurring sizable amount in bills & medicines.

I was advised to proceed to Bangalore, because of a surgery undergone by me at the end of the year 2003 there, to undergo further treatment.

I have admitted myself again at Manipal Hospitals, Bangalore, undergone a procedure and discharged after cure, again incurring sizable amount in bills & medicines.

Actually, Cashless treatment should have been allowed to me for treatment at Bangalore but in spite of the Hospital duly informing the Company, it was denied!

Later I have submitted my 2 Claims to the Company for hospitalization at Bhimavaram & Bangalore. 

After some days, a person called on me at my home saying he was from the Company. He did not bother even to introduce himself but asked me to produce the Xerox copies of the Bills. As the copies were left at Bangalore, I explained to him that the copies are not readily available. He told, without the Xerox copies, he could not verify the Claim. The bills may be spurious! Anybody can get bills as they wished!--he blurted. I asked him how could he verify the 'authenticity' of the original bills, seeing the xerox copies? He flared up and left saying he will see that not even a single rupee is paid to me by the Company.

I have immediately reported the matter to the Company CEO through their portal. I was advised that a particular person was allotted to look into the matter and the needful would be done. I have not received any communication from that person at all.

The Company indulged in prolonged useless correspondence. In reply to my mails to them, inquiring about the Claims, they used to send mails through their "do not reply" address, seeking my reply! They have marked me as a "pivotal customer" (whatever their meaning of the word be). Finally they denied both the claims. I have duly appealed to the concerned but after further prolonged correspondence, they confirmed denial of the claims.

So, I have filed my grievance with the Insurance Ombudaman, Hyderabad and he was pleased to proclaim his "award" and "allow" both the claims and ordered the Company to pay the entire claim amounts.

By now, I have received the due amounts through the Company's cheques.

I profusely thank the Ombudsman.

As I have written earlier, the Banking Ombudsman at Hyderabad did not know A B C of Banking and did not at least feel the necessity to go through the "Negotiable Instruments Act" (His Secretary and the Bank's Secretary were buddy-buddy on their personal name basis! They exchanged the Official Correspondence through their personal names!) before dismissing my complaint.

So, at least some arms are working properly!

May such arms be strengthened further.