AJAY KUMAR GOEL
New member
- Policy Name
- JEEVAN AROGYA (LIC policy No.-656402251)
- Company Name
- Life Insurance Coporation of India Divisional Office, Prabhat Nagar Saket, Meerut 250001
- Loss Amount
- 152957
- Ratings
BEFORE THE HON'BLE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM
Collectorate Complex, Meerut-250003
Ajay Kumar Goel
32/1, Ground Floor,
Sector-1, Jagriti Vihar
Meerut - 250004 (UP)
Cell: 7702112355; Email: goelapssrdi@gmail.com
Versus
Life Insurance Coporation of India
Divisional Office, Prabhat Nagar
Saket, Meerut - 250001 (UP)
Helpline: +91-22-68276827
COMPLAINT UNDER SECTION 12 OF THE CONSUMER PROTECTION ACT, 1986
Respectfully Submit as Under:
That I, Dr.AJAY KUMAR GOEL was working as Scientist-F with Andhra Pradesh State Sericulture Research and Development Institute (APSSRDI), Hindupur Sri Sathya Sai District, Andhra Pradesh - 515211 While travelling with my family, my car met with an accident on 26th December 2023 at Madanpalli, near Bangalore and both the bones of my left hand got broken. On 01.01.2024 my hand was operated and expenditure was met under Employee Health Scheme of Government of Andhra Pradesh. I have JEEVAN AROGYA policy (No.-656402251, copy attached) of LIC, since the operation cost was met by Andhra Pradesh Government, I did not submit any claim to LIC.
That on 29.02.2024 I got retired and shifted to Meerut (UP) during March. Even after about six months, when I was still suffering with pain and swelling, I consulted the Doctor at Meerut. I was told that both of my bones did not join and it was suggested to go for another operation. I visited LIC office, Meerut and got my Jeevan Arogya Policy (656402251) transferred from Andhra Pradesh to LIC Branch, CCS University Road, Meerut. I informed the LIC personally and through email about my second operation to be performed.
3. That I got operated on 28.06.2024 and I submitted the bills to LIC for reimbursement for Rs.169457/- (copy bill summary and letter attached). After submission “Discharge Summary” of first operation and some other information was sought by LIC. All the information was submitted by me on 16.08.2024 (Letter copy attached).
That, without any information to me an amount of Rs.16500/- was deposited in my account from LIC. Upon contact, I was told that this amount is the reimbursement towards daily room charges for hospitalisation. On inquiry for not reimbursing the total amount, I was suggested to visit Claim Department at LIC Divisional Office, Saket, Meerut.
5. That, I visited the Claim Department where I was informed that since this has happened due to accident and the injury caused by accident is not covered in the Jeevan Arogya health Insurance policy.
In this regard I wish to submit before the Hon’ble Court that the claim for the first operation, after accident, was not claimed from LIC. Even after six months, when the first operation failed to serve the purpose and both the bones of my left hand did not join, my hand was operated again. Thus, at the second time the cause of operation is the failure of first operation and not the accident. A “Notice” in this regard was sent to LIC office, Mumbai (Copy attached) on 14th Sept 2024. The same got delivered on 23rd Sept.2024. Till date there is no response from the LIC. Therefore, I am compelled to file my Complaint before the Hon’ble Consumer Court for relief.
Therefore, I pray for the Hon’ble Court to kindly instruct the LIC for the proper settlement of my medical bills (for operation, medicines, implants etc. ) submitted for the reimbursement.
Place: Meerut
Date: 08.11.2024 (Ajay Kumar Goel)
Cell:7702112355,
Email: goelapssrdi@gmail.com
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