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Author Topic: Wrong Information provided by Employer Regarding Group Health Insurance Policy  (Read 347 times)

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Offline bindrasam55

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I want to bring one of the issue happened to me in your notice.
 
I joined the PTC India Pvt. Ltd. on 26th December 2016 and I was provided with Group Health Insurance policy by my employer. The insurance company was New India Assurance Co. Ltd. and Mediassist works as Third Party Administrator (TPA). This Group Health Insurance Policy provides benefits for me and my dependent family member. Dependent family members includes spouse, children and both parents. This policy didn't require any medical examination to be done before commencement.

As per New India Assurance Company Limited, The terms and condition for my Group Health Insurance was supposed to be provided by my employer (i.e. PTC India Pvt. Ltd.) as they don't send this document to each individual in Group Health Insurance Policy.

My HR provided me a power point presentation (PPT) that provides information regarding Group Health Insurance Policy. However, many of the clauses and conditions are missing from this power point presentation. I checked the terms and conditions mentioned in this PPT and went for the treatment of my father. However, the claim has been denied by the Health Insurance Company as coronary angioplasty is not covered for a diabetic person for first two years of the policy. This clause was not mentioned anywhere in the power point presentation (PPT) provided by my HR.

Moreover, My details were not provided to Health Insurance Company by my employer. When I contacted the customer care department of Health Insurance Company, they told me that this detail is not yet provided by HR department of my employer, so I can't opt for cashless treatment.

Health Insurance Policy was provided as a benefit when I joined PTC India Pvt. Ltd. The company has committed that health insurance will be provided if I will join their company.

Can you please suggest if I can take a legal action against PTC India Pvt. Ltd. I have all the evidence available to support this matter.

Offline adv.amarnath

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  • Advocate Amarnath Sanyal from Kolkata, West Bengal
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If your employer has taken money for insurance or you have paid money to the insurance company then you have a good consumer case otherwise not
Regards,

Amarnath Sanyal
Advocate
Email - adv.amarnath.sanyal@gmail.com
Mob - 09830303322

 

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