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Thread: Oriental Insurance

  1. #211
    adv.singh is offline Senior Member
    Join Date
    Jan 2010
    Posts
    2,001

    Default Oriental Insurance

    DATED THIS THE 04TH DAY OF JANUARY 2010.
    COMPLAINANT

    BY-SRI.H.SHARANABASAVARAJ,

    SRI.K.G.BASAVARAJ,

    ADVOCATES, BELLARY.

    //VS//


    SRI. U. SREEDHAR,

    S/O NARAYANAPPA,

    R/AT H.NO.8/35, KANEKAL CROSS,

    KANEKAL MANDALAM,

    ANANTAPUR, ANDHRA PRADESH,

    NOW R/AT MILLERPET, BELLARY.
    RESPONDENTS

    Respondent No.1: Ex-parte.

    BY-SRI. N.JATHAPPA,

    SRI.B.V.SURESH,

    ADVOCATES, BELLARY.

    For Respondent No.2.

    1. THE DIVISIONAL MANAGER,

    ORIENTAL INSURANCE CO. LTD.,

    D.NO.10, DWARAKA, III FLOOR, 79,

    @@@@HI SALAI,

    CHENNAI, TAMIL NADU-600 034.

    2. THE DIVISIONAL MANAGER,

    ORIENTAL INSURANCE CO. LTD.,

    DIVISIONAL OFFICE, 1ST FLOOR,

    MAIN ROAD, PARVATHI NAGAR,

    BELLARY.

    //JUDGEMENT//

    Sri. S.M.Reddy, President.

    This is the complaint filed by above named Complainant under Sec-12 of C.P.Act, 1986 against the Respondents seeking damages caused to his vehicle in an accident under the Insurance Policy issued by the Respondents and also compensation towards deficiency of service etc.

    2. The brief facts of the Complainant’s case are that;

    The Complainant is the absolute registered owner of lorry bearing Regn.No.AP-21/X-4333. Since the Complainant had availed loan from M/s Sriram Transport Finance Co. Ltd, Bellary the said vehicle was hypothecated to the said Financier. The Complainant had insured the said vehicle with the Respondents through the Financier under an Insurance Policy bearing No.412000/31/2007/25944 which was valid from 06/09/2007 to 27/03/2008 and it was a comprehensive Policy covering all the risks. Further it is the case of Complainant that, on 06/09/2007 the said vehicle of Complainant met with an accident on NH-4 near Chennai in which the said vehicle was damaged and information of said accident was given to jurisdictional Police and also to the Respondents. The Respondents had appointed a Surveyor to inspect the said vehicle and assess the damages and he has assessed the damages submitted his report stating that the vehicle was damaged in the said accident to an extent of Rs.1,60,000/-. The Complainant has carried out the repairs of the said vehicle. The Complainant had handed over all the required documents to the Surveyor as demanded by him. Subsequently, the Complainant has submitted his claim to the Respondents by producing all the bills and though the Respondents had intimated that they will settle the claim immediately, but they failed to settle the claim. So ultimately the Complainant got issued a legal notice dated: 11-09-2008 and though the said notice was duly served, the Respondents neither settled the claim nor gave any reply which amounted to negligence and deficiency of service. Hence, the Complainant is constrained to file this complaint. The Complainant has claimed a sum of Rs.1,60,000/- towards spare parts charges and repairs of the vehicle together with interest @ 24% p.a. from 06-09-2007 and has also claimed idle halting charges of Rs.50,000/- damages of Rs.5,000/- and cost of Rs.3,000/- from the Respondents.

    3. Though the notice of this complaint was duly served on both the Respondents, the Respondent No.1 has not appeared, so the Respondent No.1 is placed exparte. The Respondent No.2 which is the Branch Office of Respondent No.1 at Bellary has appeared and filed its Written Version wherein, the Respondent No.2 has not disputed that the Complainant is the registered owner of said lorry and that it has been insured with the Respondents for the period from 06-09-2007 to 27-03-2008. But the Respondent No.2 has denied all other allegations made in the complaint. According to the Respondent No.2 admittedly the accident took place at Chennai and as per the address furnished by the Complainant he is resident of Kanekal Mandalam in Ananthapur District and he has conveniently stated that he is residing at Bellary and Policy is taken at Chennai Office from the Respondent No.1. Therefore, this Forum does not get jurisdiction to entertain the complaint. Further it is the case of Respondent No.2 that, the Complainant has not produced copy of D.L. or original D.L. for verification and alleged accident was reported to Kaveripakkam Police station, but FIR and Charge Sheet was not produced before the Respondents or the Surveyor concerned and as per the Survey report, the Surveyor has verified the R.C. book whereas the Pages of Fitness particulars were not found and Road Tax was paid upto 31-03-2007 only. Therefore, the Complainant has contravened the terms and conditions of Policy. Hence, the Respondents are not liable to pay any damages. Further it is the case of Respondents that, the Surveyor has assessed the loss at Rs.71,000/- but as per the bills submitted the net liability works out to Rs.50,743/- . Therefore, if this Forum come to the conclusion that the Respondents liable to pay damages and in that regard the Respondents are only liable to pay a sum of Rs.50,743/- only since there is no inordinate delay, latches, negligence and deficiency of service on the part of Respondents to settle the claim. On these grounds, he has prayed for dismissal of the complaint with cost.

    4. The Complainant in support of his case filed his affidavit evidence as P.W.1 and got marked documents as Ex.P.1 to Ex.P.13 and closed his side. As against this, the Respondent No.2 has filed the affidavit evidence of its Divisional Manager as R.W.1 and got marked document Ex.R.1 Surveyor report and closed its sides. The Respondent No.2 filed written arguments. Since the Complainant and his counsel did not avail the opportunity of advancing arguments given to him, we proceed to dispose of the complaint on merits on the basis of evidence on record.

  2. #212
    mamatha.k Guest

    Default mobile insurance claim

    My mobile insurance Was not yet settled. I filed the claim on 15.10.2013. My insurance term valid till march 2014. I would like to file a case against oriental insurance company.

  3. #213
    mamatha.k Guest

    Default mobile insurance claim

    My mobile insurance claim was not yet settled though i submitted the required documents. I filed the claim on 12.10.2013 . My insurance is valid till march 2014. I would like to file a complaint against oriental insurance regarding my claim. For further details you can contact to mamatha.kotha04@gmail.com. please help me to get insurance. Please response to my request as earlier as possible. Initiall my claim was rejected bcz in my FIR sec 382 of ipc is mentioned. After arguing they said ok we will accept that sec. Now they are giving some other reason to reject my claim. Iam really tired of convencing or arguing with them. Please help me...

  4. #214
    coolcoolvinod@gmail.com Guest

    Default mediclaim

    we have taken family floater scheme for my family for last 2 yrs ,1 week back my mom was admitted to the hospital for brain stroke for which she had to go immediate angioplasty in brain for which the total expenditure was 7 lakhs ,when we applied for cashless we were put with the query regarding her hyper tension ,when that query got solved than they rejected on the basis that the policy had to be renewed for 3 yrs after which the surgery benefit would apply,but it was not planned surgery ,it was a sudden brain stroke (paralytic attack)

  5. #215
    manishpatel is offline Junior Member
    Join Date
    Mar 2011
    Posts
    3

    Default

    I have Oriental Floater Family Health Policy since 3 years.

    In January 2014 my father went through operation for Thyroid. According to rules I have contact my agent for informing him about this operation and he told me that register a claim once admitted to hospital. So I did that and operation is over. Then I have submitted all of required documents to my agent and he told me that it will take 15 days to process.

    One day I call my agent and I ask about the status of my claim and he told me that it was rejected. Then I asked about reason. And he told me that it is due to hospital requirements. First of all I ask him everything about requirements and then he is saying it is due to hospital requirements. This is not fair enough. I have paid my premium regularly and when time came to payment they are saying it is not under their rules which are not informed to me before doing an operation.

    So now I want to file a complain against these all persons who are responsible in my case. Payment amount is big so I need to worry about that.
    Here I am giving all of my details:

    Name: Manish Patel
    Father's Name: Narbherambhai V Patel
    Policy No: 171600/48/2013/14789 (This policy is not expired)
    New Policy Number after renew: 171600/48/2014/20055
    Agent Name: Ankurbhai
    Agent Phone no: +91 94261 44793

    Hospital Name: Rakhe ENT Hospital
    Doctor Name: Dr. B. S. Rakhe

    Let me know if you need more details.

  6. #216
    S.Devarajan Guest

    Default Delaying and Dishonouring claim under health policy

    I had taken a mediclaim policy for my wife and me from Oriental Insurance Co Ltd (Kashipur Branch of Uttarakhand State) during 2012 after my retirement from employment. I purchased this policy through Punjab National Bank as an optional facility extended to their customers. I promptly renewed the policy during September 2013 (current policy number: 253801/48/2013/1577) which is valid upto September 2014.

    On January 7, 2014, both my wife and me went for a general health check up to Kauvery Hospital in Mylapore Chennai as we were told that the hospital did a thorough comprehensive geriatric check up and was worth the charges collected by them. It took about half a day for all the tests to be completed and the results to be anlaysed and interpreted to us. While waiting for our turn to discuss the results with the doctor, I suddenly developed heavy wheezing and breathlessness and requested for assistance. (I had severe cold and chest congestion for two days before the day of the check up and did not take any treatment for the same). I was treated initially as an outpatient but the trouble did not reduce and was admitted as an in patient by evening. The treatment continued and I felt better by the evening of 8th and was discharged from the hospital.

    As I was admitted to the hospital, I was told that the hospital did not have cashless treatment facility and was confirmed by the Insurers and TPA. Accordingly the TPA was informed about my admission on 7th January itself and also I requested them for the action to be taken by me fir preferring a claim. I was provided with a claim intimation no. 10158418. Later on 11-01-2014, I sent all the information and supporting documents required by the TPA for processing my claim by courier. For a long time there has been no response form the TPA despite the rigorous follow up by the OICL Manager from Kashipur (Mr Anil Gaur) and myself by emails. The TPA was not taking my telephone calls.

    When I took up the matter with customer grievance cell of OICL, nothing turned up. Later when I took up the matte with the Ombudsmen of the Insurer, I started getting responses from the TPA in March, demanding some information form the treating doctor. I had two objections on this, one the information sought for was not clear and also the matter is too late for me to approach the hospital. Then there were a couple of telephone calls from the TPA saying that the claim would be processed immediately they get the information from the hospital. I clearly perceived this as a lame excuse and requested them to send me the draft for the certificate required from he hospital which they agreed to send. I was also informed that the representative of the TPA, Mr Balaji, visited the hospital where he was refused with any information regarding my treatment and my claim was rejected. When I replied to them saying that I am taking a legal recourse, there has been some some exchange of mails between OICL and the TPA to review the case with copies of the mails to me.

    So far nothing has happened. The claim was for about Rs 7000. By God's Grace I have been keeping an exccellent health so far and hope to be so in furutre also. I have not made any health claim in the last more than 30 years of coverage under personal mediclaim policies through my employment. But the manner in which my claim was treated by the TPA (Medi Assistant), I have decided to take them for a task.

    I prefer a damage of Rs 50000 from the Insurer (OICL) / TPA (MediAssistant) for their delay / unreasonable rejection of my claim. Please advise me on the steps I have to take to go ahead with my case.

    Regards.

    Devarajan

  7. #217
    shripal H chikani Guest

    Default Regarding Agency Licence No 1551070

    Dear Sir,

    Due To mistake of earliar ro ahmedabad Dp Person My running Agency Licence delete from irda portal i have remind uppteen number of times At ORiental Ro & Ho Delhi & irda how ever Matter is pending and not any reply from Insurance Athorised employee Letter regarding New Licence As Well as continue My Licence No is 1551070 i cat renew with part of gic
    the competent authority has not taken any serious step of agency head of as a dp person for imposed rules violation who has delete my running agency from irda portal,
    kindly help me & give me right advise what can i do for continue.
    Regards,
    Shripal H Chikani
    surendranagar
    saurashtra-Gujarat
    [mob} + 91 9428292290
    Email: shripal_999@yahoo.co.in

  8. #218
    shripal H chikani Guest

    Question Regarding Agency Licence No 1551070

    Dear Sir,

    Due To mistake of earliar ro ahmedabad Dp Person My running Agency Licence delete from irda portal i have remind uppteen number of times At ORiental Ro & Ho Delhi & irda how ever Matter is pending and not any reply from Insurance Athorised employee Letter regarding New Licence As Well as continue My Licence No is 1551070 i cat renew with part of gic
    the competent authority has not taken any serious step of agency head of as a dp person for imposed rules violation who has delete my running agency from irda portal,
    kindly help me & give me right advise what can i do for continue.
    Regards,
    Shripal H Chikani
    surendranagar
    saurashtra-Gujarat
    [mob} + 91 9428292290
    Email: shripal_999@yahoo.co.in

  9. #219
    Unregistered Guest

    Thumbs down GHPL Mediclaim Insurance Sucks - BIG time

    This has been by far the most horrible experience ever! My company Spectraforce had a tie up with GHPL which was not renewed recently. The TPA ( Rakesh) is not taking it seriously now. I had submitted all related document int he past and now after 6 months, you are asking me to provide some more docs. What kind of business is this. It's been 6 months I have not been re-reimbursed. Please send me the contact details of your legal office. I would like to get my lawyer involved into this. If you want to avoid these hassles then please process my re-reimbursement. At least someone can call me and let me know what's going on. I should not suffers just because my company did not renew the subscription. You were horrible and they decided to tie up with someone else. Can someone please call me and explain what and why you need these documents when I already had submitted?

    Anurag Muukherjee
    GHPL ID:GHOI0400011469

  10. #220
    Unregistered Guest

    Default inordinate delay in process of claim

    To,
    The Oriental insurance Company Ltd.

    Services Center-II, Azad Bahawan 4E/14,

    Jhandewalan Extn, New Delhi-110055.





    Sub: - Accident Claim DL-6 CJ 9000

    Date of accident – 18/11/2013

    Insurance Claim No- 270011/31/2014/034024

    A/C – Jasmine.




    Ref: - Letter No- 270011/31/2014/034024 Date: - 18/03/2014

    Sir,

    It is unfortunate to apprise the attitude of Oriental Insurance Company as well surveyors is oppressing & prejudice. In the above mentioned case the following facts be noted before rejecting this case.
    1. It is false that letter of dated – 24/01/2014 was never issued or received by the undersigned.

    2. That insurance company & surveyor M/S M.S Uppal did not respond to the damage cost and estimate since 18/11/2013 to march 2014.(About 5 Month).

    3. The surveyors was requested to direct/instruct the work shop to start repairs , but he did not take action so.

    4. The surveyor did not confirm either to scrap the car total loss or get the repairs.

    5. The vehicle had CNG endorsed since April 2012 and Oriental Insurance Company Carried out special survey accordingly prior to it.

    6. The Oriental Company agent always apprised me that CNG risk included in the policy repeatedly, but factually did not include it.

    7. The Surveyor M.S Uppal was very arrogant and did not listen us and acted autocrately

    8. Further the undersigned and my representative hand visited at least 8 times to M.S uppel office and called at least 50 time over telephone to request to expedite since Dec – 2013 to Feb – 2014.

    9. The estimate of the response were above 1.6 lacks submitted to Mr M.S Uppel but he himself made it to Rs 16,000 and decided not to pay more than Rs 7,000 /- Rs 8,000.Accessed by junior surveyor.

    10. It is not understood how the surveyor decide the payment without giving any justification.

    11. How the surveyor asked and received blank paper signed two times, Cheque book, crossed cheque repeatedly since Feb 2014.But refused to give direction to the workshop as well as us.

    12. At present the vehicle is being repaired at my own and the bills the cost of repairs be refunded.

    13. Further the CNG risk cost be levied from me and 100% risk be covered of the policy.

    It is therefore requested that proper investigation is needed to be conducted and the official of Oriental Insurance from insurance agent to surveyor.
    Further it is the mischievous deed of M/S uppal and later Oriental Insurance Company to reject the claim on sided.

    I am ready to pay the risk of CNG value and repair at the base price of Rs 55,000 /- be fixed to the undersigned.
    Jasmine

    H-53 Ashok Vihar ,

    Phase-1 , Delhi 52

    Contact tel 9810211908 Anil

  11. #221
    Unregistered Guest

    Unhappy we are not getting claim

    sir we are not getting a claim ,manager says nothing your claim will come ,the time has to take two years .aur ab puchte hai to kehta hain mil jayega.tell me what should i do.plz help me about this matter my contact no. is 8791884570...

  12. #222
    RITESH BHAVSAR Guest

    Angry Denined my claim since 3 yrs

    dear sir,
    My self ritesh Bhavsar & My Policy details as mention below for your reference.

    Due to Retinal vein occlusion of my mother Eye , doctor suggest to use OCT INTRANTREAL AVASTIN injection for my mother operation,but oriental insurance company rejected my claim due to only that this is OPD treatment but as per My mother condition she operated in Operation Theatre & he rest more then 24 hours for this treatment also doctor give all back document for Claim process as per requirement of oriental insurance company.

    But No one can give any positive responce for My claim Process.
    I hope you give me positive responce & Help me to Process my claim.

    For more details Pls contect me on 9727116101 or mail me on riteshbhavsar1987@yahoo.com

    My Policy details as mention below:

    NAME : RITESH V BHAVSAR.
    ID: MDI5 - 0006578948
    MY POLICY NO.: 171400/48/212/1449


    Regards,
    Ritesh Bhavsar

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