Harassment by TPAs

Regn No.PN 4769 (Regd under Indian T U Act, 1926)

(Affiliated to Bharateeya Mazdoor Sangh)

BMS Office, Vishwakarma Bhavan, 185, Shaniwar Peth, Pune 411030.

President: T.C. Gunesh Kumar Mob No: 9880683639

General Secretary: Ashok J. Joshi Mob No: 9561084182 & 9945104570

Date: 23-03-2024

To, The Sr. Divisional Manager New India Assurance Co. Ltd. DO Code 120700 Mumbai

Dear Sir/Madam,

Sub: Harassment by TPAs

I am the all-India General Secretary of National Organization of Insurance Pensioners (BMS), representing more than 8000 members throughout India.

• •
  I have been receiving hundreds of complaints from our members regarding the various types of harassments being meted out to our members for settlement of their claims.
• •
  More complaints have been received from 2 TPAs - MD India Ltd and MediAssist Ltd.
• •
  Unfortunately, all the TPAs are applying GIPSA/PPN rules to settle the claims of LIC of India clients.
• •
  Please find the policy bond attached. And all the TPAs should and must see the conditions contained in the said policy bond while settling the claims of policy holders of LIC of India.
• •
  They are calling for unnecessary requirements, deducting certain items which are payable as per the policy document.
• •
  Wrong deductions under non-medicals are being made, though these charges are payable as per the policy document.
• •
  Though the original cash receipts are submitted, they say that they have not received and ask the policy holders to submit (this is the most callous and deliberate attempt on the part of the TPA to deduct these charges, saying receipts not received).
• •
  Even they have been harassing the patients under critical condition/cancer patients etc, which action of theirs is most despicable and condemnable.
• •
  They create unnecessary psychological pressure through such harassment and it appears that they wish the patients to die at the earliest. They lack absolutely the sensitivity of the matter and behave irresponsibly.
• •
  Please find one such harassment meted out to the undersigned as a live example. Even in another case of mine 6 years back, the TPA MD India called for original cash receipts though they were sent pasted on a sheet of paper. When I threatened, MD India Ltd settled my claim.

In view of the above we earnestly request you to –

• 1.
  Instruct your TPAs to strictly act as per the conditions of the group Mediclaim policy of LIC of India.
• 2.
  Not to apply GIPSA/PPN rules in our case.
• 3.
  No to harass unnecessarily by asking to submit the documents/original cash receipts already submitted with the claim papers.

We hope that necessary instructions would be issued by you accordingly.

Thanking you,

Encl: As above

Yours sincerely,

General Secretary (Ashok J Joshi)