1 Jan, 2018 → by ClaimboUser924797
Medical insurance claim rejected
*SOLVED

3

I, Mr.Raj Iruthaya Ambrose had purchased a LIC`s Health Plus Plan with profits on 13/02/2008 covering my family i.e. wife, son and daughter.Premium was Rs15000 to be paid yearly through ecs from my bank account at PMC.First payment was made by cheque no.916002 for 15000.But in the month of march 2008 they (LIC) deducted Rs15000 through ecs this was brought to notice of LIC agent Mrs.Veena Sandip Gawli and asked her to inform the branch but again in the month of april 2008 Rs15000 was deducted this time i informed the branch, the call was attended by LIC, DO Mrs.Dani who assured me this wont happen again and she would refund the excess deducted after contacting her office at Hyderabad.After that i made it a point to keep below Rs15000 in my account.After repeated complaints no action by the Kalyn Branch 92D.My wife suddenly had severe stomachache she visited her family doctor in August2008, again the stomach pain reoccurred after 15days she was refered to a Gyno.She after doing all the test diagonised it as cyst in ovary it was the start, after a months medication she adviced her to get it operated to avoid further problems as pain was coming and going.She was operated in November for Hysterectomy on nov.8th 2008.I had informed the agent Mrs.Veena and also told her i would take legal action if i was not refunded the excess Rs30, 000 deducted from my account only after that they returned the money through cheque no 119550.My wife was discharged on Nov.15th2008. Itook all the necessary papers to the kalyan branch they said they did not have the claims form as this Health Plus Scheme was new and they awaiting for the forms from Hyderabad.So i gave the papers to the Agent Mrs.Gawli, i regurarly kept in touch with her.She got the forms in Dec 2008.After all the formalities were completed the form was submitted.In january 2009 i received a letter M/S Paramount the TPA for LIC that the claims request form was submitted late.When i informed the agent and the branch office about it, they said as the delay was from their side they would request the TPA to consider it.Till today i.e.january 2010 nothing has taken place. Now i want them to refund the intial amount paid by me i.e. Rs15000 to me as soon as possible.Also to take necessary action on the incompetent Agent and the Manager of Kalyan Branch 92D.My policy No.is924353854.
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