PREJUDICIAL INSTRUCTIONS TO T.P.A. ON MEDICLAIM

09.02.2015

To

The General Manager (P),

The New India Assurance Co. Ltd.,

87, Mahatma Gandhi Road,

Mumbai – 400001.

Dear Sir,

We have come across an information that the Corporate HRM:EWS has advised  TPAs involving settlement of claims under current Staff Group Mediclaim Policy issued by United India restricting payment through cheque made by the insured Mr. L R Ringshia, Ex-AGM, New India directly to surgeons and not forming part of the Hospital Bill. The direction/guideline issued by your Corporate HRM stipulates that the quantum of Surgeon fee and Anaesthetist Fee shall be the maximum of 25 percent of the Sum Insured and fees paid in cash up to Rs. 10,000/- will be reimbursed provided the numbered bill issued by the concerned doctor is submitted. 

We have perused the said policy but there is no such restrictive provision.  Moreover when the policy has been issued by the United India Insurance Co Ltd how the New India Corporate HRM arbitrarily could issue instruction to the TPAs altering the terms and conditions unilaterally keeping all concerned in the dark.  Further any mid-term alteration of terms and conditions of the policy will be strongly opposed by us as it amounts to breach of the policy.

In view of the above we would request you to   intervene into the matter and direct the officials concerned to withdraw this prejudicial instruction so that the insureds are not   deprived of their entitlement with respect to quantum of claim amount.

We do state in this context that The United India Insurance Co. being the insurer in the instant case,  in all fairness we should be guided squarely by terms and conditions of the policy issued by U.I.I. without any variation whatsoever.

A line in confirmation in this regard shall be appreciated.

Thanking you,

Yours faithfully,
Sd/- xx xx xx
SUJIT BAGCHI
GENERAL SECRETARY,
N.F.G.I.E.