Fraud in Travel Insurance

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COMPLAINT-2.
(Submitted to the Hon. Insurance Ombudsman,Bangalore against Religare Health Insurance Company Ltd., India)

Ref1 : My IRDA Complaint No. 01-18-009299 under Travel Insurance Policy No. 11789181 issued by Religare Health Insurance, INDIA for $ 100,000 USD,

I am deeply hurt and aggrieved by the manner in which the Insurance Ombudsman functions. They dismiss your complaint  against the Insurance company despite the circumstances of the case where the company in a most illegal and inhuman manner rejected my claim for emergency medical care on foreign soil and imperilled my life by exposing me to grievous risks despite me being insured with them to the tune of $ 100,000.

Subsequently,  I have re-approached Religare by sending them all the bills incurred by me for the said medical treatment. I have patiently waited for 1 month but Alas! there has been no response from them regarding reimbursement and therefore I lodged this complaint2 the Ombudsman/IRDA to conduct a fair and impartial enquiry/investigation against Religare before rejecting my complaint yet again and letting Religare go Scott Free only to embolden them to perpetrate such frauds against our esteemed countrymen in utter disregard to human life but to no avail.

GIST OF COMPLAINT-1 :


(Submitted to the Hon. Insurance Ombudsman,Bangalore against Religare Health Insurance Company Ltd., India)


Ref: My IRDA Complaint No. 01-18-009299 under Travel Insurance Policy No. 11789181 issued by Religare Health Insurance, INDIA for $ 100,000 USD,

Preamble: I travelled to Thailand as a tourist from India between 20-Dec-2017 upto 1-Feb-2018. During this entire period I was covered by Travel Policy No. 11789181 issued by Religare. On 29/12/2017, I developed Chest discomfort and pain at Pattaya and visited the Bangkok Hospital for treatment. The Cardiologist who examined me advised immediate hospitalisation for some investigations and observation. The hospital sent an estimate of 72,000 THB to Religare and asked for pre-authorisation/payment guarantee for treatment expenses which they rejected in a most inhuman manner without assigning any reason whatsoever. Later, they called me and assured me that they would honour my claim and obtained some medical documents and details from me by deceit. They then back stabbed me by using these against me, alleging that I had concealed information and therefore my claim was being rejected. They played grave fraud on me and denied me medical care inspite of me being fully insured to the extent of $ 100,000 USD with them. Please find below a brief description of the fraud they have played on me:-

1)That they, (Anoop Singh, Grievance Redressal Officer/Religare) are blatantly lying to IRDA (see their entries in IGMS) with malicious intent to make wrongful gain that, my cashless claim is for OPD treatment less than 12 hrs and therefore fit for rejection and I have to/had to self pay and seek reimbursement.

2) That, the hospital has directly conveyed to them that the treatment contemplated is IPD (inpatient) for at least 24 hrs and has also sent them an estimate for 72,000 Thai Bhat, requesting them for urgent pre-authorisation/guarantee of payment which they have illegally rejected in a most inhuman manner citing untenable reasons when I have been suffering from Chest Pain all along — they have exposed me grave danger tantamount to an attempt to kill/murder me.

3) I request you to carefully examine each and every e-mail correspondence I have had with them, copies of which I have sent to complaints@irda.gov.in. I have also recorded every telephonic conversation I have had with them which I shall furnish to you as further supporting evidence to prove the grave fraud played on me and the likes of which our every county-men are in danger of, at their cruel hands unless checked by law.

Under these grim circumstances, I humbly pray to the Hon. Ombudsman/IRDA to:

PRAYER:

1) TO AWARD THE FULL SUM INSURED AMOUNT OF $ 100,000 USD SO THAT I MAY PURSUE QUALITY MEDICAL TREATMENT AND TRY HEAL AGAINST THE GRIEVOUS DAMAGE INFLICTED UPON ME BY OFFICIALS OF RELIGARE HEALTH INSURANCE, INDIA.

2) TO IMMEDIATELY REPUDIATE AND CANCEL THE LICENCE ISSUED TO RELIGARE TO OPERATE AN HEALTH INSURANCE BUSINESS IN INDIA THUS SAVING CRORES OF OUR HAPLESS COUNTRYMEN FROM SLAUGHTER AT THEIR HANDS ON FOREIGN SOIL.

THANKING YOU,
BEST REGARDS,
-MOHAN KUMAR CAVALE
9538439490

From: Mohan Kumar Cavale <religarehealthinsurance.com; complaints@irda.gov.in
Cc: complaints@irda.gov.in
Subject: Re: Rejection Letter/Religare/Mohan Kumar Cavale/11789181/IN0300021905 CRM:005480836

You are misinterpreting for wrongful gain and continue to play fraud on me. I have clarified that I do not have full fledged type ll dm. Also, no diagnosis can be made based on a CT angiography and it is not necessary to declare this, as it is not confirmed diagnosis, but I have declared cholesterol. Ask any doctor. Even so you have a ped clause under which you could have accommodated my claim. I have been fully honest with frauds like you. I will take it up with irda and assure you that I will fight hard to make you pay full sum assured of $ 100,000 as damages for this fraud.
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From: FGA India Assistance <fga@in.falck.com>
Sent: Thursday, January 11, 2018 9:56:53 AM
To: mohankc@hotmail.com
Subject: Rejection Letter/Religare/Mohan Kumar Cavale/11789181/IN0300021905 CRM:005480836

Dear Sir/Madam,

This email is in reference to cashless claim for Mr. Mohan Kumar Cavale.

We regret to inform that as per the medical documents/information received, we will not be able to extend cashless facility.

Please find the attached Rejection letter for your reference.

Should you have any query, please feel free to contact us.

Regards,
Nitin Dhingra
FGA India

List of documents enclosed:

1) Complaint Form
2) Consent Form
3) ANNEX VI-A
4) Gist of Complaint
5) Preliminary medical report advising hospitalisation for 24 hrs or more due to chest pain dtd 29/12/2017
6) Estimate for 72,000 Thai Baht advising hospitalisation for 2 days+1 night sent directly to Religare by hospital.
7) CLAIM REJECTION LETTER BY RELIGARE DTD 10/01/2018
8) E-mail sent to Mr. Anoop Singh, GRO Religare on 19/1/2018
9) Unacceptable Reply from Religare dtd 30/1/2018 reiterating claim rejection.
10) Policy cover note, 20/12/2017 to 05/01 2018.
11) Policy cover note, extended from 06/1/2018 – 01/02/2018
12) Detailed Policy document ( 40 pages)

 



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