COMPLAINT FORM Name : Janardhan Laxman Dhopate Res.Add : At Post Devalgaon Avchar Tq Manwat District Parbhani 431515 Telephone No : 8888139839 E mail.[d : janardhandhopate@gmail.com To, Office of the Insurance Ombudsman, Jeevan Darshan Bldg., 3rd Floor, C.T.S. No.s. 195 to 198, N.C. Kelkar Road, Narayan Peth,Pune - 411 030 Policy No : CRP-10-20-7516846-00-000 Name of Insurance Co : Future Generali India Insurance Co. Ltd. Branch : Maharashtra, Pune Extent of Loss : 250000 Relief sought from Ombudsman : Claim to be paid Kindly mention gist of your complaint | would like to raise a complaint against the rejection of the Covid Positive hospitalization claim by the company on the grounds that the patient needs only self-isolation by Home Quarantine as per the covid guidelines of AIIMS and Health Ministry. learnt that AlIMS has issued guidelines that are not meant to replac: the clinical judgment or the decision of the treating Doctor of the Hospital for Covid patients. The General Insurance Council has also written in the guidelines for covid rates that ultimate judgment regarding the treatment must be made by the physician and the ensuing medical condition of the patients. canned WI aamscannerTruthfully, was having high-grade fever and was admitted to the Hospital from 29th Octcver 2020 till 4th November 2020. Thus the Hospitalisation was a necessity to control the lung infection due to this corona infection. In view of the Genuine Hospitalisation required for the covid treatment, | pray to the Senior Officers of the honorable ombudsman to review the case and settle the covid positive claim as per the terms and conditions of the policy. Your Pro 1pt meditation in the matter will be highly appreciated and give justice to the policyholder by safeguarding the interest under the policy as per the IRDA guidelines. I request to the honorable ombudsman to please consider my case for hearing and help me to settle my genuine hospitalization claim. Specify the photo copies of the documents being submitted along with Complaint letter for consideration such a 1.Policy copy 2:Representation to the Grievance Redressal of Insurance Company Rw’ Signature scanned with CamscannerANNEXVLA To, ‘Tre insurance Ombudsman, 3rd Floor Jeevan Darshan Bg N.C.kelkar Road, Narayan Pet, Pune 411030 Complaint No, PUN H.016-2122.0031 ‘Re: Complaint against Future General india Insurance Co td. (Mumbai) ‘ranch/ Division: Mumbai Policy No. :Covid-19.CRP-10-20-7516846-00-000 ‘Mr Janardhan Laxman Ohopate ‘Being aggrieved, am lodging complain against the above referred Insurance Company. Detallsare given asunder 4. Complainants full Name and Address Name Adsress: Telephone No. Landtine Wo, Mobite No: eral Relationship tothe Insured Person 2Name of the Insurance Co. ttice address Division Branch: 3. Policy Number: 4 Subject Matter of complaint and brief fats ofthe case 5. ate of preferring your laim/ complaint tothe office (please enclose copy ofthe letter) 6 Date of reply of insurance company. (please enclose a copy ofthe letter 7. Are any proceedings before any Coun/ Consumer Forum/ -Arbitator onthe same subject matterpending or were so eaier £8. Nature and extent of monetary Loss, if any, (Incase of General Insurance cases only): 9. quantum of relief sought: 410, (a)Particulars of representation made agnnst repudiation Me Jonardhan Laxman Dhopate ‘At Post Devalgaon Avchar Ta Manwet, Parbhani, Maharashta-€31515, eena120029 (email Future General india insurance Co, te. (Mumbs) UnitNos 801 & 62 th floor, Tower C, Embassy 247 Park BS Marg Vikhel West Mural 400083 umbat 9RP-10.20-7516646 00-000, scanned with Camscanner(faim t0.00/ RO/20/Grievance Cell and outcome thereof (6) Hot made representation give reasons, if any SS 11 [hereby decare and solemnly affirm that 2} The information given above is true to the best of my knowledge and belief 1 The &paint was lodged with the Insurance Com: . Jone and th anyones percony enclosed and the company has reeeted my ei comp at notreplied even after amonth/ replied on but the same is not acceptable to me. : ” The period af one year has nt elaps from the date of rejection letter or final fom the insurance Company. 4) The complaint isnot on the same subject matter for which any proceedings before any court or consumes forum or abitator are pending/ setled or were sealer. 1 The subject matteris not decd eatierby your oie or any office ofthe Insurance Ombudsman. 12.1/ We enclose copes ofthe following documents 4. Copy of complaint letter written tothe insurance Company, 2. Copy’ ply received fromthe sid insurance Company, 3.Copy eminder, if any. Yours faithful, (signature ann, te, The insurance Ombudsman, 3 Floor leevan Darshan Bldg NeCkelkar Road, srayan Peth, Pune 411030 Dear si, Re: Complaint against: Futore General nai insurance Co. td (Mumba) ranch /Dvsion: Mumbal Polley No, :Covid-19 CRP-10-20-7516846-00 000 Name : Me, lanardhan Leman Dhopate Your References X-¥-016-2122.0031 ith reterence to you leter dated [letter date_of annex 6] onthe above subject. We hereby give my/ouruncondtional and revocable consent forthe Ingurance Ombudsman to act a8 mediator, between the Insurance Company and myself and give his recommendations for the resolution of complaint. “thereby give my content for Audio and/or Video Hearing, If the prevailing conditions are not conducive fr hearing nthe Office of Insurance Ombudsman". If yes, lease tick ¥) Kindly give your recommendation a the earliest Yours fait (sehante) scanned with Camscanner