Dose any premium collected for Medical Insurance ? If yes than can appraoch Consumer court.
Well, an employee is also a consumer and has every right to enjoy the benefits he is entitled to. Issue legal notice, if no relief approach consumer court.
Regarding Medical Insurance claim
Hi, I am a corporate employee and covered under the corporate medical insurance. My company has tied up with a TPA called FHPL, who is our contact point for any medical insurance related matters. Recently, i underwent a surgery for which I submitted 2 bills, 1 from hospital and 1 bill for surgeon expenses. When i submitted them to the 3rd party, he did not give any comments. but now, after more than 2.5 months, he is asking for a single bill that includes the total expenses. I approached the hospital for the same, but they are unable to alter the bill now. The TPA is also not accepting their fault. How can i take this issue forward?. Is it possible to raise a complaint in consumer court regarding the same?.
Asked 6 years ago in Civil Law
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11 Answers
This is no issue. A single bill can be generated by the hospital. If they are unwilling then raise this issue with the employer. Otherwise file a consumer complaint.
Regards
Sort it out through your internal channels.
Adjudication and legal expenses shall put you in depression .
Regards
G.Rajaganapathy
High Court of Madras
1. You have no control over the details of the Bills an as along as the Bill contains final figure and your payment is made then your job is done and the insurance company is bound to reimburse the insured money.
2. So of the insurance company is not paying the money is it appears then you have a good case where you can file the case before the consumer forum herewith you will get money claimed along with enough damages, compensation and interest on the money witheld by the company.
Yes then since companies want to pay your insurance bill as it is a legitimate claim you need to send them a legal notice in this regard that the requirement has not been pointed out at the time of submission of the bill and now at this point of payment unnecessary queries are being raised you can request them to pay the bill after 15 days of getting the notice otherwise you can move your complaint to the consumer forum which may decide in your favour as this is a fit case of shortage in services
Issue legal notice to TPA for settlement of your bills
2) if they refuse file complaint before consumer forum seek reimbursement of expenses incurred by you
3) enclose copy of bills submitted by you
issue a legal notice through an advocate to Tpa and file complaint before district consumer court and claim bills along with compensation.
You first get a letter intimating that the insurance company will not pay the claim amount for the said reason, after that you can approach consumer forum for deficiency in service as well as for unfair trade practice, seeking compensation besides claim amount with interest.
Yes you can file a complaint as you are beneficiary of the same
Yes you should send them a legal notice for claiming the medical expenses.
If they refuse to refund the amount of bills you can file case in consumer forum against the insurer.
Yes, first make a written complaint to the insurance company. If there is no response or satisfactory response, lodge a complaint with the Insurance Ombudsman.
