Case 1)
We had received a complaint from Smt. Kanta Bhadury, of 88, K.B.M., P.O. Chakdaha, Dt. Nadia regarding inordinate delay in sanctioning a claim under mediclaim policy No.154302/48/07/8500001263 (Policy period from 20.03.2008 to 19.03.2008) from National Insurance Company, Ranaghat Branch and/or from the TPA of that Company M/S Medsave Health Care, Kolkata - 700016 for her deceased husband Late Debasish Bhaduri.
We enquired into the matter and had been understood that the claim was rejected by the TPA due to alleged discontinuation of policy and non-production of a discharge certificate by the Tata Memorial Hospital, Mumbai where he was treated. On going through the available documents it is understood that the deceased consumer was continuing his policy under the Company since 2005 and only a two days discontinuation was occurred to his policy in the year 2007-08 which caused due to some unknown problem of the Agent/DO/Company etc. as the deceased paid the whole amount in time. Though it does not comes under the preview of declining of claim as it is a matter of previous year and in the current year he is very much covered with the policy.
Secondly, as the deceased was suffering from killer decease of Cancer his family members were not in a position to inform the company in time and even they did not have any knowledge about the discharge certificate issued from the Tata Memorial Hospital, Mumbai. For such reason once they informed the TPA that the discharge certificate was not issued from the Hospital. On returned back from Mumbai the patient was admitted in a Kolkata Nursing Home where he died. Finally as per our advice they further contacted with the Hospital and brought a copy of the discharge certificate.
We took up the matter and given notice to the both Insurance Company and TPA to release the insured amount of Rs. 1 lakh immediately as there is no ambiguity of the claim. We on several occasions contacted with the TPA and the Company and finally we succeed to release the whole amount of sum assured of Rs. 1 lakh to the widow of the deceased.
Case 2)
In May, 2009 one Shri Bikash Chandra Haldar, Vill. Baliadanga, P.O. Chakdaha, Dt. Nadia had made a complaint to us that he was purchased a mini diesel generator (Honda) set for some time back from M/S S. K. Dhar & Brothers, D.L.Roy Road, P.O. Krishnagar, Dt. Nadia for his domestic purpose and it is gone out of order due to some of its technical faults and on two occasions he was compelled to carried it to the dealer’s shop at Krishnagar, a distance of more than 50 kms. for its repair but still it is not okay and giving troubles. The dealer has further asked him to carry the machine to him for its further repair and for these inconveniences he has fallen in an extreme agony and trouble.
We took up the matter and send a notice to the dealer to change the machine but it was observed that the dealer did not receive the latter and on the contrary he contacted with the aggrieved consumer and informed that a mechanic of the Company is going to his house for its repair. Accordingly a mechanic came and repaired it and the consumer was satisfied with its functioning. But with in a day or two it further came out of order and informed us. We further given a notice to the dealer. This time also they did not receive the letter but informed the consumer that he may brought away the generator to his shop which will be refunded and the whole amount will be returned.
On our further advice he met the dealer along with the generator set and instantly he refund back the entire amount in cash.
