Jammu, Oct 6:The mandatory insurance policy-Reliance Group Mediclaim Insurance Policy-for government employees and pensioners of J&K is again caught in controversy, as the company has refused to settle health claim of a pensioner who had paid the first instalment of policy on October 1.
The patient is undergoing treatment in a hospital and the cost of treatment runs into several lakh, but the company has refused to pay the patient.
The state government had widely advertised the policy and made it mandatory for the government employees and pensioners to get it. The advertisement in newspapers states that the Group Health Insurance Policy has been approved by the J&K government. The policy awarded to M/s Reliance General Insurance Co. Ltd was rolled out with effect from October 1, 2018.
A retired government employee, Jagdish Mitter Kapahi, is admitted at the BL Kapoor Memorial Hospital, Delhi, after complaints of acute pain in the chest.
“After consultation with the doctors, we brought him (Jagdish) to the hospital and there we came to know that his gallbladder stone is stuck in the CBD pipe. For the removal of the stone, the patient must undergo surgery, which costs approximately Rs 6 to 7 lakh,” said Jagdish’s son Deepak Kapahi.
Though the Reliance Mediclaim policy is claimed to be cash-less, “when we provided the details of the policy to the hospital management, they said that since my father is a pensioner, he is not not covered under the policy,” said Deepak.
“My father had taken Reliance’s Mediclaim Insurance policy. On October 1, he paid the first instalment of Rs. 4957 and the amount was debited from my father’s pensioner account. In particulars it is written as PENSION092018, dated 1-Oct 2018 MEDICAL INSU-92018”, Deepak said.
He said it was shocking news for them as the Reliance Company has deducted first instalment from his father’s the bank account but denied to cover the policy and now the hospital administration is demanding cash from the patient.
“When I approached the Trinity Reinsurance Broker Limited through email, I received an email from one Mr Kundan Kumar, which reads: ‘Sorry for the inconvenience. The pensioner is not covered in the policy. Kindly bear with us. The same will be covered once the policy is booked in 2-3 days’,” Deepak said, adding that after sending another email to them, there was no reply.
He said they were suffering a lot after the denial of insurance cover and have been asking the relatives for financial help so that surgery would be performed within days.
“It is gross injustice and loot of the pensioners as you took money but are not settling claim of the insured person”, Deepak said.
When contacted, a Trinity Reinsurance Broker Limited representative who attended the call, said, “Sir is busy, you please call later”.
When this correspondent made a repeated call they asked to contact helpline number and said that there was no official available to talk with media.
“This is total fraud to refer helpline number, once they will deduct the money they are not going to pay attention and the repeated calls of the claimants will be diverted towards helpline number and usually the people at helpline numbers showed their reluctance or simply forward the complaints to higher ups”, an official said.
