Scams in India ..IRDA is no exception and goes down to Insureres, TPA's and hospitals..

Slno	ClaimNo	Auth. Date	ClaimType	PolicyNo	Cardno	InsuredName	PolicyHolderName	HospitalName	DateOfAdmission	DateOfDischarge	CaslessRequestAmount	CashlessGrantAmount	ClaimedAmt	FinalDisallowedAmt	ApprovedAmt	SumInsured(SI)	BalanceSI	ClaimStatus	Remarks	Deduction Reason	Chequeno	ChequeAmount	Chequedate	Awb. No.	DispatchDate
1	UN-3-143160		CASHLESS	021200/48/11/20/00000547	AHUN0300643135	VIMLA	SANJAY JAIN	MITTAL HOSPITAL AND RESEARCH CENTRE	31/07/2011	31/07/2011	100000	0	0	0	0	110000	110000	Query Raised For Cashless Authorization

 

The M. D.,
Alankit,

Pl. note that I am the husband of agent of above policyholder and also relative of policy holder. Agent is attending to serious ill mother in ICU hence I am doing this correspondence.

With reference to above this is to state that ur site as above shows patient discharged. However patient is still in hospital.
1.Pl. inform how did you get this false info that patient is discharged.
2. Being service organization normally TPA's should come under RTI. Pl. clarify.
3. Your site says:  Query Raised For Cashless Authorization. Pl. inform what query has been raised?
4. Why the query is not uploaded on ur site with other above details?
5. You have asked for 10 years policy copies from hospital. Is hospital suppose to possess such copies??
6.Is policy holder suppose to possess such copies / records of 10 years?
7. Does 10 years copies mean you want bribe of Rs. 10000/- to clear cashless?
8.Is it true to get TPA license your company has bribed to Chairman IRDA 10 crore ??
9.Is it true that insures pay you higher fees for delaying / harassing/ refusing claims.
10. Is it true that when u ask for details from insurers they ask bribe from you so you insist info from hospitals who do not have such info and can not have such info. And finally after under hand dealing you approve cashless and the effect is that that hospitals are left with no choice but to overcharge, follow unethical means to recover bribe paid to you ( and u paid bribe to IRDA for TPA license like we see in case of spectrum licenece and all other posts by eagles and  appointed by eagles/ Govt  ).

Pl. reply to all queries one by one as matter is going to go to consumer court.

CC to others : In one line while the senior citizen was on death bed ( ICU in bad condition) instead of TPA / Insurers harassed for 3 days asking for policy copy of 10 years fronm hospital and in turn hospital asking from patients relative.  If I describe the whole episode of harassment meted out then may be some of u will have tears in ur eyes. But that is a sorry state of India contollede by bureaucrats. That is why we want LOKPAL BILL OF ANNAJI. And imagine where claimanet is senior citizen, paying 12500/- p.a. for over a decade for a policy of just Rs. 1 lac and they are made to run pillar to post.

And if I go to Ombudsman, or to consumer court or anywhere all r seated there thru back door/ corrupt practices , influence, caste system etc so no one will listen to me and I will waste my life in stinking corridors of these officers.

Hence I do not have any faith and hope in our system,.

Will some international body intervene. Can UNO put pressure on India to humanize its brutal system headed by lusty bureaucrats?? 

--
Thanks and Regards,
Alok Tholiya,

RE: Urgent reply solicited from IRDA chief

Reply to all

bosco coelho to me

show details 5:22 PM (22 hours ago)

Good Evening sir,

After reading i certainly agree to all the the points you have mentioned, I would like to highlight on one such incident as in if a career part-time agent could not complete his or her specified lives or policies mentioned as per IRDA for the agency year or license year, the commission of all those policies which are already processed; the agent does not receive a one single penny from those policy(s) premium or premium commission for entire life and in turn the agent is demotivated and negativity is being created in the agent's mind for that specific insurance company and yet the agent is bond to give service to all those existing policy holders at his or her own cost which i feel is totally unacceptable and IRDA and all the insurance companies should collectively seriously think about it.

IN HUMAN SOLIDARITY

Thanks & Regards

Bosco Coelho
Insurance Advisor
Verticals - Life Insurance, General Insurance & Health Insurance 

Voice - 9923298656

Email - bosco_coelho@hotmail.com

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From: atholiya@gmail.com
Date: Thu, 14 Jul 2011 18:09:55 +0530
Subject: Urgent reply solicited from IRDA chief
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Request to all to fwd this mail to IRDA chief and FM. Alok


The Chairman,
IRDA,
India

Dear Sir,
Namaskar.
Pl. note that all those who are looking for buying a policy are getting half deal/ half info and lot of misguidance.

We wish to clarify thru u on following:

1. Why Personal accident policy is stopped by all insurers at the age of 70 yrs? Earlier to formation of IRDA all insurers were giving PA policy for life. My mother was covered even till the age of 87 yrs and I have those documents with me. But now due to blessings of IRDA and entry of private insurers everyone is giving cover only up to 70 yrs. Pl. explain. 
2. Most health policies are stopped by insurers at the age of 80 yrs. Why? If one buys policy at the age of 25 and survives till 90 then in spite of paying insurance co. he is thrown out by insurers after the age of 80 years. This has happened only after IRDA was formed. 
3. Brokers  have benefits of infinite no. of staff and infinite no. of branches. So they should be working on turn over. But because IRDA wanted that way the insurers are giving officially 30 % commission to them. Then they give 45% discount to car owners then what r the insurers left with? Besides brokers are killing career small time agent by giving away portion of their commission to customers and thus snatching away business of small time career agents. 
4. Insurance is a very committed and personal touch affair and needs service back up. However staff of banks and brokers sell insurance either by discounting or by arm twisting. But who will give service? They keep switching jobs/ keep getting transferred etc etc..
   
5. The claim level can go up when one is above 60 years of age. And there r many single senior citizens in bedridden condition or so. A career agent used to go to their house and give all support or service. But all insurers have reduced their commission to 5% so giving that service is not possible. While brokers and financial institutions don't give home service to ailing old clients yet get 30% commission on the directive of inhuman policies of IRDA. 
6. Most insurance companies specially LIC, and Govt general insurance cos dont update their site for years, don't give all the forms , tariffs, etc on their web site, they don't reply to emails, they don't generate policy in stipulated time and IRDA shelters them.Why?? AMFI / SEBI has made time and date stamping a must for all mutual fund houses and new IPO's and they have to act on applications in stipulated time, they have to refund money in stipulated time as time is punched on every transaction but due to the blessing of IRDA these insurers take their own time at their sweet will. While a agent from family of manager of insurers or brokers who are ex insurance company seniors get their work done in time but other agents are kept dragging because IRDA behaves as sold our hand in glove organization. Like 2G and 3g scam their is a scam in appointing brokers too. 
7. All insurers are refusing to cover poor persons for less then s 1 lac sum assured for health. Is this the directive by you?
8. All insurers are not promoting and are least interested in covering senior citizens. While world is extending all assistance to senior citizens but for IRDA and insurers. 
9. Most insurer s are not settling claims in time frame.
10. Most insurers are not giving commission and TDS certificates to agents in time. Why?

I request you to explain and clarify all my queries , disclose all facts or I will be filing an RTI against my above letter and chase u on these issues.


--
Thanks and Regards,
Alok Tholiya

Re: Urgent reply solicited from IRDA chief

Request to all to fwd this mail to IRDA chief and FM. Alok


The Chairman,
IRDA,
India

Dear Sir,
Namaskar.
Pl. note that all those who are looking for buying a policy are getting half deal/ half info and lot of misguidance.

We wish to clarify thru u on following:

1. Why Personal accident policy is stopped by all insurers at the age of 70 yrs? Earlier to formation of IRDA all insurers were giving PA policy for life. My mother was covered even till the age of 87 yrs and I have those documents with me. But now due to blessings of IRDA and entry of private insurers everyone is giving cover only up to 70 yrs. Pl. explain. 
2. Most health policies are stopped by insurers at the age of 80 yrs. Why? If one buys policy at the age of 25 and survives till 90 then in spite of paying insurance co. he is thrown out by insurers after the age of 80 years. This has happened only after IRDA was formed. 
3. Brokers  have benefits of infinite no. of staff and infinite no. of branches. So they should be working on turn over. But because IRDA wanted that way the insurers are giving officially 30 % commission to them. Then they give 45% discount to car owners then what r the insurers left with? Besides brokers are killing career small time agent by giving away portion of their commission to customers and thus snatching away business of small time career agents. 
4. Insurance is a very committed and personal touch affair and needs service back up. However staff of banks and brokers sell insurance either by discounting or by arm twisting. But who will give service? They keep switching jobs/ keep getting transferred etc etc..
   
5. The claim level can go up when one is above 60 years of age. And there r many single senior citizens in bedridden condition or so. A career agent used to go to their house and give all support or service. But all insurers have reduced their commission to 5% so giving that service is not possible. While brokers and financial institutions dont give home service to ailing old clients yet get 30% commission on the directive of inhuman policies of IRDA. 
6. Most insurance companies specially LIC, and Govt general insurance cos dont update their site for years, don't give all the forms , tariffs, etc on their web site, they don't reply to emails, they dont generate policy in stipulatd time and IRDA shelters them.Why?? AMFI / SEBI has made time and date stamping a must for all mutual fund houses and new IPO's and they have to act on applications in stipulated time, they have to refund money in stipulated time as time is punched on every transaction but due to the blessing of IRDA these insurers take their own time at their sweet will. While a agent from family of manager of insurers or brokers who are ex insurance company seniors get their work done in time but other agents are kept dragging because IRDA behaves as sold our hand in glove organization. Like 2G and 3g scam their is a scam in appointing brokers too. 
7. All insurers are refusing to cover poor persons for less then s 1 lac sum assured for health. Is this the directive by you?
   
8. All insurers are not promoting and are least interested in covering senior citizens. While world is extending all assistance to senior citizens but for IRDA and insurers. 
9. Most insurer s are not settling claims in time frame.
   
10. Most insurers are not giving commission and TDS certificates to agents in time. Why?
    

I request you to explain and clarify all my queries , disclose all facts or I will be filing an RTI against my above letter and chase u on these issues.



Alok Tholiya


--