Consumer Redressal

To, CONSUMER REDRESSAL FORUM, Mumbai Suburban Dist, Administrative building, 3rd Floor, Bandra Govt.Colony, Near C.B.D., Bandra (East), Mumbai 400 034. Dear Sir, Sub : Policy Hospital Care No.08048875 – Prudential ICICI Life Insurance This is in reference to captioned policy claim given by me for my hospitalization for the following period: 28th May 2012 to 29th May 2012 – Nityanand Hospital, Vile-Parle(East) 29th May 2012 to 2nd June 2012– Asian Heart Institute, Bandra (East) I, Mr.Sanjay Kalsekar, age 50 years, was hospitalized in above Hospitals as I was not feeling well and it was diagonised that I had suffered an Heart attack and later Angio-graphy and Angio-plasty was conducted on 30th Aug 2012 and I was kept in ICU and hospitalized till discharge on 2nd June 2012. Please note the following points in regard to the same : 1. Policy premium of Rs.9,639.00 was paid on 28th May 2012 through net banking payment option from my Axis bank account after confirmation from Prudential ICICI Life Insurance Customer care that the policy will be reinstated immediately after paying the above amount which includes penalty payment/late fee. ..2/- - 2 - 2. Mail dated 31.05.2012 confirms reinstatement of policy with effect from 29.05.2012. 3. I have followed up for the claim status on 01st Aug 2012. Till then, I was not informed regarding the same. The Customer Care official telephonically stated that claims are rejected on the grounds that Hypertension has not been disclosed while taking the policy. I checked my Policy application and I had very much disclosed the same and in fact I was charged additional premium for the same. The same was telephonically informed by me to the Customer Care official. 4. Then, Prudential ICICI Life Insurance came up with another reason for non-payment and vide mail dated 01st Aug 2012 stated rejection of both the claims under clause 8B. 5. In reply to my mail dated 13th Aug 2012, regarding clarification to clause 8B, Prudential ICICI Life Insurance mail dated 17th Aug 2012, states details of clause 8B which is reproduced below. 8) Payment of premiums b) Premiums are payable on the due dates mentioned in the Policy Certificate or within the grace period allowed without any obligation on the Company to notify the Life Assured/policyholder of the due dates. If the premiums are not paid on the due dates or even during the grace period, the policy lapses and no benefits shall be payable. 6. On clarifications of the above mail dated, I was informed vide mail 06th Sept 2012, that no benefit to be given to the policy holder if the signs and symptoms are falling in the lapsed period. 2(vi) is reproduced below for your reference- 2. Revival of the policy: A policy, which has lapsed for non-payment of premium within the days of grace, may be revived subject to the following conditions: vi) Even after revival, no benefit is payable for an event which occurred or symptoms of which occurred during the period when the policy was in lapsed condition Thus, I was given various reasons for non-payment of claim as above. 7. I am repeatedly requesting Pru ICICI Life Insurance via mails dated 12/09/2012,17/09/2012,25/09/2012 & 03/10/2012 requesting them that my claim should be processed once the reinstatement takes place ie from 29th Aug 2012. My hospitalization in Asian Heart Hospital was on 29th Aug 2012 evening 6.00 pm. ..3/- - 3 - The Angio-graphy and Angio-plasty was conducted on 30th Aug 2012 and I was kept in ICU and hospitalized till discharge on 2nd June 2012. I also requested that Pru ICICI Life Insurance should consider the reimbursement for Asian Heart Hospital expenses. The Nityanand hospital expenses may not be given as per their agreement. I have made timely payments all these years and this years premium was not paid due to oversight as I was confused with my other policy payment with Pru ICICI. 8. Pru ICICI Life Insurance have not sent any intimation for the non-payment of premium either through mail of letter that my policy is discontinued/lapsed. If the same had been informed to me, I would have not paid the premium of the policy. Kindly oblige and advise me regarding the above and I sincerely request that my claim should be considered favourably. Thanking you, Yours sincerely, Sanjay Kalsekar