Claim not settled by Bajaj Allianz - India Consumer Forum

Claim not settled by Bajaj Allianz

I do regular pay bajaj alliance mediclaim premium since 2010

I am working as an incharge in one of the private hospitals. i was on duty and suddenly i felt sick hence i asked my bajaj alliance agent through whom i have taken mediclaim policy that if dr. advise me to admin and i would admit then will my mediclaim be passed? he replied me that i need to be hospitalized at least for 24 hrs in order to settle the claim and accordingly i did the same after consulting the physician and i hospitalized for 24 hrs.

In order to pass my claim i have submitted all the necessary documents but later on i got the rejection letter from bajaj alliance indicating that there was no need to be hospitalized as per your “Line of treatment” hence i am writing details for the case.

1) first of all i was been informed that i need to be hospitalized for 24 hrs(which i did) however not been informed “Line of treatment” condition in which claim will not be settled.

2) when i was on duty i felt sick and immediate i consulted physician hence i can not be considered that i was normal as per the knowledge of physician consultant he immediate advise me to be hospitalized as i was suffering from fibromyalgia and it is very critical condition. physician knows all such things.

3) In my treatment there were I.V injections and come to know by studying my file. however dr. was unable to take I.V line even after needle prick and it was not tolerable in terms of pain and being a patient i have all right to refuse I.V treatment and requested alternate option which was oral treatment. i was not aware if i refuse and take this treatment by alternate option as mentioned then claim would not be passed otherwise i would have taken this treatment through I.V mode anyhow,

The above information was not been provided by bajaj alliance agent and my claim got rejected. if i would aware about such condition then i am not fool to take such worthless decision.

Being a middle class person we are totally depends on mediclaim and in fact we took mediclaim to get financial support in such condition.

Bhavika Rathod
Nadiad 387002, Gujarat
19/06/2017 / 10:15 am

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