This is with regard to “6 Mediclaim Blunders To Avoid” by Raj Pradhan (Moneylife, 1 October 2015).
I am happy to read your magazine, where you highlighted how insurance companies are rejecting genuine claims with minor and unjustified clauses. I would also highlight my experience with Star Health Insurance, where I have escalated my concern with all the authorities but all efforts have been in vain so far.
I have taken a Senior Citizen Red Carpet Insurance Policy for my mother. She was hospitalised in a non-network hospital at my native place in Rajasthan and so we had to claim all medical expenses. I made a claim in September 2014 with submission of all required documents.
These documents were clearly checked by their employee, Sachin, at their Vashi branch in Navi Mumbai, and he acknowledged their receipt. They had taken more than 20 days to confirm that they had received the claim at their claim help desk. Later, I received a communication from them stating that they require the same documents which I had already submitted. I had also given my consent to the insurance company that they could contact the hospital, if they require any additional document or had any query. But the insurance company was knowingly delaying my claim and not providing any justification. Later, they rejected my claim on 9 December 2014, citing that I had not submitted the required documents and so they were not able to process my claim. This is despite the fact that I had confirmed during a conference call with their grievance executive Megha Maharana and Vashi branch employee Sachin that they had received all the required documents.
I had escalated this issue to their nodal officer but I have not received any answer, as of now. I had also raised this with IRDAI (Insurance Regulatory and Development Authority of India) and Bima Lokpal (insurance ombudsman), and I am awaiting their resolution. I believe they are just collecting money for a cause but not supporting when we require it the most. My insurance claim intimation no: CLI/2015/700002/0117627
Please take up this complaint on a priority and teach Star Health a lesson; they need to abide by the rules which are drawn by the insurance authority.
Manish Modi, by email
Star Health’s reply:
The claim arose in the first year of our Senior Citizen Red Carpet Policy no: P/700002/01/ 2014/018661 which was started on 20 February 2014 with a sum insured of Rs2 lakh covering Hemalata Modi, 60 years of age. The insured person has taken treatment in a non-network hospital in Rajasthan, the diagnosis being Right Foot Cellulitis. The hospital carried out the procedure of incision and drainage under local anaesthesia. Hospitalisation was between 23 and 28 August 2014. The claim was intimated on 26.8.2014 and the documents were received at our corporate office on 15.10.2014. On 23.10.2014, we advised the insured to furnish the following:
(a) Original discharge summary with all original investigation reports. (b) Letter from the treating doctor mentioning the probable aetiology of cellulitis, duration of DM (diabetes mellitus), other co-morbidities, if any. (c) Indoor case papers, OT notes. (d) Any previous history of hospitalisation with discharge summary, investigation reports. (e) Original receipt for the amount paid to hospital. (f) Hospital registration certificate copy.
The insured responded by mail on 3.12.2014 taking the plea that he has submitted whatever he had and if any further information/documents are required, we should approach the doctor/hospital and obtain them. In fact, he has not disclosed the health condition of the insured which ought to have been within his knowledge, namely, duration of diabetes mellitus and other co-morbid conditions and the cause for cellulitis. In most cases, the primary cause for cellulitis is longstanding diabetes or arising out of an accidental injury. Further, in terms of the Senior Citizen Red Carpet Policy issued to the insured, any treatment arising out of a pre-existing disease/condition is not payable in the first year of the policy. Hence, the insured was asked to submit the aetiology of cellulitis and duration of diabetes mellitus. As the insured has not submitted the relevant documents in support of his claim, we had no option but to reject his claim in terms of the following condition of the policy issued to him :
“The Insured Person shall obtain and furnish the Company with all original bills, receipts and other documents upon which a claim is based and shall also give the Company such additional information and assistance as the Company may require in dealing with the claim...”
If the insured submits the documents called for, we shall be in a position to re-open the claim and deal with it in terms of the policy.
SAVE TIME AND HARASSMENT!
This is with regard to “5 Steps for an Easier Tax System” by Ameet Patel. In many countries, such as Australia, personal taxation is a breeze... every cent is in the system and refund takes two weeks! Remove the plethora of deductions that people have to claim and have a flat system of tax. Submission of documentation by salaried class is another pain. For a large country like India, the process has to be swift. A few percentage points here and there can be avoided to save time, harassment and paperwork.
Aditya Singhal, online comment
ABOLISH INCOME TAX!
Point number one is spot on. How much time and energy is wasted on such a small point—TDS or tax deduction at source—which is nothing but a nuisance, at the worst. The best thing is that, as Dr Subramanian Swamy states, abolish income tax (I-T) and have a 1% bank trainsaction tax. No I-T returns will then need to be filed. No I-T office required! This will improve ease of doing business, when implemented.
Suketu Shah, online comment
This is with regard to “Stock Manipulation: Viaan Industries”. Obviously, it is a money laundering operation.
Peejay Lal, online comment
ALERT FOR INVESTORS
This is with regard to “Ashok Leyland on a Roll in September quarter”. Thanks; this is an alert call for investors. Please do post similar reviews/observations on other stocks as and when you feel it right.
TEDIOUS AND TIME CONSUMING!
The article by advocate Bapoo Malcom, “Will Your Will Be Willed Away?” is quite an interesting article.
In India, depending on the situation and circumstances, oral Wills are allowed and valid. A Will, which is written by the testator in his own handwriting, need not be witnessed by two persons. However, after the demise of the testator, when probate has to be obtained for such special Wills, it becomes a tedious process. Even when a testator has landed property or a house in different states of India, when his probated Will from one state goes to the High Court of another state, and after it goes to district court of that state, where that real estate is situated, the Will’s probate is checked by that court, and court orders transfer of the said property in the name of legatee.
This is a tedious time consuming and costly process.
Shirish Sadanand Shanbhag
SPEEDY JUSTICE NEEDED!
This is with regard to “Collateral Damage of the 1992 Scam” by Sucheta Dalal. Unfortunately, India's judicial system has become a tool for culprits to delay matters ad-infinitum. Lack of accountability of the judiciary is creating crisis. As a remedy, it is available only to the privileged few. No government has ever done anything substantive to dispense speedy justice by strengthening the institution.
Mr Bavdekar may eventually get acquitted, but he will not be compensated for the decades of torture.
Rajendra M Ganatra
Corrections: (1) The author of the Cover Story of Moneylife (Issue 26 November 2015), Ameet Patel, is a partner of Manohar Chowdhry & Associates and not as mentioned. (2) In Stock watch “Strong Get Stronger” Moneylife (Issue 12 November 2015), there were mistakes in calculation of the price changes. However, the names of the top 19 stocks picked for the analysis were unaffected.