My Complaint is as follows: I am having Group Medical Policy since 2013. My agent Amrita Engineer (Benchmark Insurance) used to handle all my policies. Till 2016 my policy was with Karvat Travel Services Pvt Ltd. From 2016 the policy was transferred to Fortune Health Plus Pvt ltd. Policy was of United India Insurance (Master Policy no [deleted]P111425956) which was to expire on 29 Oct 2017. Hence I paid Fortune Rs. 26,908 well in advance via 2 cheques for which I have the receipts. They en-cashed the cheques but didn't issue any policy. In the meanwhile my father suffered heart attack and had to be hospitalized in December. We weren't aware that they still haven't issued policy as they never informed us. When I tried to get cashless settlement they said some technical difficulty is there you pay we will get the claim settled. After following up with Fortune Health Plus for 2 months they issued a policy but now date was not from Nov 2017 but from 23 Jan 2018 ! (Oriental Insurance | Policy number [deleted]) In March/April 2018 we received "Pre-Settlement Note" for Rs. 143265. But till now we haven't heard anything from them. I guess this is breach of service and can be bracketed under "Fraud" as they collected the cheques on time but kept us in dark the whole time about status of policy issuance. New policy which they issued should have been from Nov 2017 but it is from Feb 2018. When contacted Oriental Insurance they informed us that this policy is not valid. Then 2 months ago they issued another policy admitting previous one is not valid. Please help as I am unaware whom to hold responsible and what to do about this. Even after contacting them repeatedly they are not returning my calls. When raised issue with IRDA they closed the issue saying there is no problem at their end as my father was not insured at that time.
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Sir file a consumer complaint agaisnt them Company can be filed as you have timely paid the amount and further got reciept of same, it is failure and deficiency on there part to not to issue the insurance so claim amount from them along with compensation for mental stress and litigation charges.
You can send them a legal notice first if on notice they are not ready to pay the amount file a complaint in same.
Your agent is at fault
2) he collected money from you in advance for renewal of policy but did not pay insurance company on time
3) file complaint against agent before consumer forum for deficiency in service
4) seek to recover amount paid by you for non renewal of policy
5) also claim compensation for mental torture undergone by you
You have couple of options:
1. Approach Consumer Court and file a case against whom you issued cheques (Fortune Health Plus) making the insurance company also the party. Make everyone you interacted with from the agency a party. Keep it simple, say you issued cheques but they did not issue policy and due to which you are unable to claim medical insurance for your father's medical expenses. Also say that Oriental Insurance stated that that policy waswnot valid. This will be the fastest and the cheapest relief. You will have to explain to the court as to what were you doing all these days without approaching earlier. Give a proof that cheques were encashed but policy was not issued. Later policy was issued which was fake.
2. Register a fraud case (criminal) against the agent in the police station. This will put pressure on them. And with the police you say, a fake policy was issued, which the Oriental Insurance said was not valid. Here register complaint against all the people whom you have interacted with regarding the insurance. Do not give any original documents to the police. At the max, give a copy only.
3. Register an online complaint for free at http://corecentre.org/
Do 3rd point immediately. Then 1 and then 2.
If you are convinced/satisfied with my answer please rate it. This will encourage to serve better.
1) You can file case against Insurance Company for breach of contract in the district forum consumer court.
You first issue a legal notice demanding the insurance claim amount for your father's treatment expenses based on the cheque you issued and it was duly encashed.
If you dont get any response or if they do not comply with the demands made, you may drag them to consumer forum seeking compensation as well as claim amount
I forgot to mention; we had signed a "Pre Settlement Note" in the month of May. They (Fortune Health Plus Pvt Ltd) said as soon as we sign this we will receive the cheque in 2 days and this is part of process. That note stated as below: "Received with thanks from Fortune Health Plus Pvt Limited Rs. 143265. I/We have agree to accept the given amount and Pre-Settlement Note." We signed on revenue stamped document. I understand this is bad and we shouldn't have done it. But we have done that and now that stands. Will this affect my case in consumer court? I can show the bank account statements and trail of SMS later on which clearly states they haven't paid me yet.
you can only recover Rs 143265 from fortune health which has been agreed to be paid to you
issue legal notice to said agent to pay said amount agreed upon
Yes this will effect but you can dispute same as they have to show them proof of amount disbursed to you.
Further you can produce the account statements and later conversation evidencing that payment is not received.
you can approach the insurance ombudsman or file a civil complaint against the insurer before a civil court
See if they say they have paid, they have to give all the details of DD number etc. So don't worry. But make sure you mention everything in your complaint.
Most of the cases are lost because they don't tell everything to the court first itself. So be clear in your consumer complaint.
If they have not paid the said amount then you can issue a legal notice demanding the same.
Based on the records and documentary evidences you can very well drag them to consumer forum too.
Yes this will effect your case, but you may say that the said signature was taken forcefully and ask the court to direct the company to show the details of the transaction
