Non settlement of mediclaim by MDINDIA TPA

From: Sita Ram Agarwal
Date: 4 June 2020 at 1:08:39 PM IST
To: co_eos
Cc: customercare@mdindia.com
Subject: Fwd:  Mdindia - Online Claim Submition Module.    CCN:MDI 5325131 TP00512070019900381681 FVG PUSHPA AGARWAL  POST-HOSPITALISATION CLAIM

MADAM S MAHATO
MDINDIA, PUNE

I have received a msg yesterday from your office that I should submit the claim documents through email or wattsapp on account of Covid-19 and therein a long list of documents has been given to be submitted through electronic mode.

I think this msg is in respect of new claims. My case pertains to post hospitalisation and all the required documents, with claim form, has  been submitted to LIC on 20-02-2020,  for Rs 1,59,873/-,which forwarded it to your office. I have not kept copies of any document, so sent, as I did not feel any necessity for the same.

Your Office passed the claim for Rs 89,047/- on 11-03-2020 and this amount was paid to LIC on 17-03-2020 and after a week I received this amount from LIC.

I sent a Representation to your Office on 19-03-2020 against the deduction of Rs 59,472/- with copy to LIC ànd I was informed that it has been sent to the concerned team for processing.

Your Office then passed the claim for Rs 59,472/- on 30-03-2020 during Covid19 period and sent the amount to LIC on 08-04-2020 again during Covid-19 period. But in the Claim Payment Sheet, your Office  have not given the details of deduction of Rs 6,575/- and for the remaining amount Rs 4,779/-, I have again given the required clarification. Thus a sum of Rs 11,354/- has been deducted from post-hospitalisation claim.

I have again sent a Representation on 10-04-2020 against deduction of Rs 11,354/- and your Office sent me an email on 19-04-2020 that it is under process, which may take 7-10 days. Since I have not received any reply for more than 4-5 weeks, I sent 2-3 reminders and now in reply thereof, your Office says to submit claim on email or WhatsApp with a long list of documents. This all happened in Covid-19 period.

My most of the correspondence has been on electric mode and during period of Covid-19 and your Office has processed the claim and made part payment during Covid-19 period and I have sent all documents to your Office and I have none to submit again through electric mode. It seems there is a lack of coordination in your concerned team, as my case pertains to non-payment of a small amount from the pending claim submitted on 24-02-2020 and the same has been processed 2-3 times and part payment made 2-3 times including Covid-19 period.

You are requested to personally look into this matter and settle the pending amount at an early date as more than 6-7 weeks have passed trim the date of email of your office dated 19-04-2020 that processing will take 7-10 days.

Thanks,

S R AGARWAL
Retd Secy,
LIC,CO
S R 207257
Mob 8527571711