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 vijay mehra (Guest)
please advice me whether after the decision of insurance ombudsman i can file a complaint in the consumer forum for the redressal of my grievances
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Replied on Thursday, February 5, 2009 12:00 AM
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kamlesh thakkar (Guest)
May I know how to lodge a grievance complaint with the Ombudsman regarding Health Insurance? Pl advise.
Regards,
Kamlesh
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Replied on Wednesday, February 18, 2009 12:00 AM
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Guest
For Obmudsman - India
Is there any formal procedure for lodging a complaint with the Ombudsman?
Yes. The Procedure is very simple. The complaint can be written in a plain paper and be submitted. If the complaint falls within the terms of reference, the forum will issue specific forms to the complainant.
4] Is there any fees / charges payable to the Ombudsman for lodging a complaint?
No. There is no fees/charges that need to be paid to lodge a complaint.
5) Is there any time limit to approach the Ombudsman?
Yes. One year from the date of rejection by the insurer or from receiving the Insurer's final reply to the complainant's representation.
The maximum limit for the amount under dispute is Rs. 20 lakhs.
Read more: Ombudsmen - FAQs http://www.medindia.net/patients/insurance/Health_Insurance_Ombudsmen_faqs.htm#ixzz0pE0ziB4O
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Replied on Friday, May 28, 2010 12:00 AM
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Janice (Guest)
As The maximum limit for the amount under dispute is Rs. 20 lakhs...with whom should i file a complaint for amount greater tham 20 lac
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Replied on Monday, March 2, 2009 12:00 AM
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My Company chose a different Health Plan with another company this year. They cover Colonoscopy every 10 years instead of 5 years. I had colon surgery 2 years ago for a small polyp. The doctor wants me to have a Colonosciopy this year. They will not cover it because they say it is pre-exiting. Is this legal, I did not change Insurance Plans, my company did. My doctor considers this preventitive, the Insurance Company does not, and will not cover it. I am 60 years old. I also took out disability insurance so that I would receive $1800 a month, if I get sick. United Health is saying if it is related to your colon you will only receive the $1,000 the amount you had previously. How is this fare, if I am paying to receive $1800, why would I only receive the $1,000. Is this legal?
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Replied on Monday, April 20, 2009 12:00 AM
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Sir,
Why is there no transparency? Why does the ombudsman not allow the insured to take help of the expert at the hearing? There is imbalance between the Insurer (with all insurance/mediclaim acknowledgement)& the Insured who is ignorant of intricacies of Insurance/Mediclaim terminology. This is imbalanced justice.
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Replied on Friday, February 12, 2010 12:00 AM
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Guest
Ombudsman office runs on documents and evidences and not on the arguments. So the experts, agents and lawyers are not allowed.... You can show your documents and share your views directly.
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Replied on Tuesday, March 23, 2010 12:00 AM
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