Manipal Cigna Health insurance - MEDICAL HEALTH INSURANCE CLAIM REPUDIATED
ABHIJIT SINHA filed complaint against Manipal Cigna Health insurance on May 15, 2024
To take care of my medical need, post exit from work, I took a health insurance from Manipal Cigna for insured value of Rs.******/- on **.**.****. I contributed to the ever-increasing yearly premium without fail. The last premium of Rs*****/- was paid for Pro Health Prime protect Policy No. PROPRM********* dated **.**.**** for insured sum of Rs ******/-
I had a gallbladder operation (Laparoscopic Cholecystectomy) on **-**-**** at Tata Main Hospital, Jamshedpur, Jharkhand. I lodged a claim for Rs,*****/ with Manipal Cigna Health Insurance Co.Ltd on **, January **** for which acknowledge of receipt with claim No.******** was received.
The claim was frivolously rejected by Manipal Cigna :
*.First objection was ICR not submitted even though submitted through E-Mail as well as physically at their local office in Jamshedpur.
*.Next Manipal Cigna insisted for clinical note. It was astonishing that I had to explain Manipal Cigna that clinical note is same as the prescriptions submitted in original with claim documents.
*.Then came the charge to submit past discharge summary of Mastoidectomy which happened ** years earlier.
My defence was : I asked for the potential connection of my ** years old mastoidectomy with current reimbursement claim for Laparoscopic Cholecystectomy which was never answered.
I wrote to Manipal Cigna ‘ I was a teenager that time and under the care of my parents. Neither my father not the doctor and the nursing home is present currently so I am unable to submit the discharge papers.’ I also proposed that the existing scar due to mastoidectomy may be checked by Manipal Cigna allotted/referred doctor to understand the age of the surgery.
Fortunately, I found a prescription of **.**.**** on which notably another ENT doctor had mentioned a reference to my old surgery. It evidenced that that the mastoidectomy was not a current surgery but an old surgery. Manipal Cigna was forced to endorse the mastoid medical condition on **.**.**** in the policy with same terms of currently existing policy.
*. Next charge from Manipal Cigna: Papers related to anxiety treatment not deposited. Claim repudiated on the ground of “denial clause disclosure of information”
My defence: My policy PROPRM********* against which claim repudiated was initiated on **-**-**** a time when I was off medicine. Moreover, potential connection of my anxiety treatment with current reimbursement claim for Laparoscopic Cholecystectomy are unrelated medical condition.
*.My policy was forfeited by Manipal Cigna in event of non-disclosure of material fact on **.**.****.
My defence: The Policy PROHLR********* was ported to PROPRM********* and claim was against ported policy.
a) Anxiety Disorder is not a terminal medical condition.
b) It does not have any connection with Laparoscopic Cholecystectomy for which claim was made.
c) The disclosure of anxiety treatment was made by me by voluntarily submitting all medical document to Manipal Cigna. An endorsement of the medical condition should have been made rather than forfeiting the policy.
d) Manipal Cigna cannot forfeit the policy and repudiate claim as it is a violation of The Mental Health Care Act ****.
*. Even after the policy was forfeited on **/**/**** I found myself puzzled by the numerous phone calls, SMSs and E-mails urging me to renew my policy. I was even provided with a link for online payment. Despite my confusion, with call assistance of Manipal Cigna I was eventually guided through the process and successfully made online payment of the premium amount of Rs.*****/- on **th. December ****.
Only after writing E-mails the amount was returned back after about *.* months.
I would like to request for the following:
#*. An assurance from Manipal Cigna that each and every claim of its IP will be looked into without prejudice and evaluation process will be fair and unbiased. They should have genuine intent to extend humanitarian support reflecting the values of compassion and empathy towards its insured clients.
#*. I am formally requesting compensation equivalent to the sum assured for abatement of my anxiety over a prolonged period of above a year causing significant distress and impairment in my daily life, potentially violating provisions of The Mental Health Care Act ****.
#*. Manipal Cigna to calculate the claim amount of Rs,*****/- with an added *.*% interest for the waiting period from claim date, to account for the deliberate intentional delay.
#*. Renew the terminated policy PROPRM********* with continuity from the forfeited date **.**.****.
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