united india insurance , TPA is harassing for reimbursement .

878 votes

1. You are being threatened by them, it may be your opinion. But if legaly going, it amounts to compliance of procedure to settle the claim. So what is the difficulty in this- produce all the required documents i.e. A-z Bills incurred by you on her treatment. And when operation happened on 22.6.2016 and you intimated them through their agent on 13.6.2016 then there is no delay in intimation. And preferably give them any proof of delivery of information to this effect- your recieving of document slip, your diary entry, you phone record or any, so that they are satisfied with your submission.
2. If you have more than one policy for the same cause then you have right to claim from both severally and collectively. But it does not mean you will get more than your claimed amount.

Advocate Lata Lochav LawRato

917 votes

Sir,
From your query it is clear that you have a proof of the intimation made by you, via SMS, prior to the date of operation and therefore there is no reason to worry as you have complied with the Policy requirement. You have further stated which is not clear and i quote." I informed TPA (Manager) telephonically and by SMS/MMS for the intimation on 20-06-2016 with Claim form." If this means that you submitted the claim form or asked for the Claim Form, you can re-submit a copy of that claim form again as proof which should most likely be processed by the Insurance Company. And in case, you had not submitted a Claim Form, as you have complied with the Intimation Clause, you can submit the Claim Form now, alongwith proof of intimation, as usually claims are valid for a substantial period. But, it would be best if i could see a copy of your Policy and tell you what step to take in accordance with the Terms and Conditions of Policy.
Regards
Adv. Daggar Malhotra

Advocate Daggar Malhotra LawRato