Complaint Details

Status	:	Closed
Complaint No	:	0080631/2016
Category	:	Insurance
Date	:	26-08-2016
Subject Line	:	Non settlement of the claim settled
Complainant	:	PRATHEESH
Address	:	MODERIYATH , PARAMBIL
Complainee	:	HDFC GENERAL INSURANCE
Address	:	HDFC ERGO General Insurance Co. Ltd. 6th floor, MBC Tower, Old no. 90, New no. 199, Luz Church Road, Mylapore Chennai - 600 004

Complaint Details
My name is Pratheesh . I am from Calicut in Kerala . My address is Moderiyath house , Parambil (po) , Calicut , Kerala -673012 . I have taken my Mediclaim insurance policy two years back from HDFC Ergo and is still continuing the policy . . My HDFC mediclaim policy number is 29522013121315000 . My wife has undergone medical treatment on 19-07-2016 due to pain in stomach and had undergone laparoscopy on 27/07/2016 . I have submitted a claim on 05-08-2016 .The details are shown below

Patient Name : DEEPA T M
HDFC ERGO ID : ER1502229094-02W
CCN No : RR-HS16-10366354
Hospital Name : JJ IVF GYNAE CENTRE
Hospitalization Period : From 27/07/2016 to 28/07/2016


I have send the following documents
1) Filled application
2) Original medical bills
3) Discharge summary
4) Pharmacy Bills
5) Hospital main bills

All the documents were attested by treating Doctor . On 09-08-2016 i was asked to submit Treating doctors certificate , Original reports against bills , Indoor case papers . As a result i have send the following documents on 16-08-2016 . Again i got a query asking for treating doctors certificate . I have replied that i already have send the same and finally an executive called from HDFC ergo saying the documents are in order and i will get the claim with in 7 days . On 26-08-2016 i have again received a mail asking for

1) Treating doctors certificate
2) Indoor case papers
3) Post op Histo pathology report, USG report etc .


My wife has undergone laparoscopy and i understand that no USG report is there . More than two times HDFC Ergo officials visited and talked to the hospital where treatment was undergone and was convinced . Also an official from HDFC Ergo came to my home , talked to my wife and collected the details . I have submitted the entire documents received from hospital , in addition the Doctors Certificate , Indoor case sheets , Investigation reports etc . Still insurance company is not settling the claim Sir . I am feeling dishearted due to the approach of the insurance company and also some of the calls from the executives of the HDFC Ergo general insurance company is so rude and treating me as beggar asking for money . Kindly request Sir to look into the matter .

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