SANKET CHANDILA

Advocate, District & Sessions Court

Faridabad, Seat no. 106 & 145
Judicial Court Complex,
Faridabad – 121007
Mobile: +91 9711727747
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Legal Notice Dated: 08/09/2019
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To,
Religare Health Insurance Company Limited
Regd. Office – 5th Floor ,19 Chawla House,
Nehru Place, New Delhi-110019

Service Branch- RHICL, Vipul Tech Square , Tower C, Third Floor ,

Sector-43, Golf Course Road Gurugram -122009
Through its Directors & Managing Concern

Subject: Colossal distress and inconvenience caused to my client

Mrs. Vidya by sheer unprofessional conduct of your
company by not rendering her cashless mediclaim and
also denying her reimbursement of the same without any
cogent ground, displaying utmost negligence in their
duties towards their costumers.

Sir, 

Under the instructions of my client, Smt Vidya W/o_Late Sh. Pratap

Singh, I hereby serve upon you the instant legal notice on account of the
colossal inconvenience and distress caused to my client by Religare
Health Insurance of which you the noticee is a Director and managing
the affairs of the same., who displayed utmost negligence in their duties
towards my client.

The situation at present has arisen as a result of all the events that have
occurred till date and which have been listed hereunder for your perusal:
1. That my client namely Mrs. Vidya holds a valid mediclaim policy
issued by you the noticee and is insured with your company since
16.12.2107, also she duly got renewed the said policy bearing
number 11844345 on 16.12.2018 by paying a premium of Rs.
18498/- ,the sum assured of the said policy is Rs. 500,000/- and it
is valid till 15.12.2019.
2. That the said policy was a cashless policy and
3. That on 19.01.2019 my client got hospitalized in QRG Central
Hospital, Faridabad and her cashless mediclaim card was produced
at the time of her admission by her attendant namely Mr. Jitender
Chaudhary who happens to be her nephew, but cashless treatment
was denied to her for the reasons best known to the noticee
company and it’s Claims Department.
4. That on 23.01.2109 my client got discharged from the hospital and
a total bill of Rs. 57445/- was paid by her as the noticee company
had already denied her the cashless Mediclaim facility which was
promised to her at the time of issuance of the said policy.
5. That Mr. Jitender Chaudhary , nephew of my client who was
taking care of her and was looking after all the things related to her
hospitalization and Mediclaim, on 04.02.2019 had applied for
reimbursement of the said denied claim after completing all the
formalities as told to him by claims department of the noticee
company.
6. That on 07.02.2019 e-mail confirming the receipt of the said
reimbursement claim from the claims department was sent to the
email id of nephew of my client Mr. Jitender Singh informing him
about the claim no. to be REM0702201900019 and it was also
assured that said claim would be processed in 15 days.
7. That on 19.02.2019 Mr. Jitender Singh received an e-mail from
claims department and an unwarranted query was raised on your
part, although the same was duly responded by Mr. Jitender Singh
and he had dispatched the desired documents via speed post to the
claims department on 22.02.2019 and informed the claims
department about it via e-mail on the same day. In response he got
a confirmation e-mail from the claims department on 26.02.2019
informing him about the claim to be under process.
8. That on 11.03.2019 Mr. Jitender again reminded the Claims
Department about the said claim through e-mail but received no
 response from the claims department , but he was hopeful that the
said claim would be settled as promised , but to add to the misery
of my client again the said query reminder letter was sent to him
through e-mail on 19.03.2019 which had been duly addressed
earlier and the same was informed to them via email dated
20.03.2019
9. That on 22.03.2019 the Claims Department asked for NEFT form of
my client as it was required in the process of reimbursement of the
said claim via email. The said NEFT form was though had already
been sent to them via speed post earlier but it was again sent to
the Claims Department 0n 27.03.2019 by Mr. Jitender on behalf of
my client and the same was also informed to the claims department
vide e-mail dated 28.03.2019 with a request not to prolong the
process by unnecessarily delaying the said process for no justifiable
reason.
10. That on 29.03.2019 the Claims Department acknowledged
the same and informed Mr. Jitender that the claim was under
process. But eventually on 30.03.2019 it was informed to my client
that her claim had been denied via e-mail and a claim denial letter
was attached. Surprisingly the said claim was shown to be denied
on the basis of queries which were duly addressed multiple times
on behalf of my client.
11. That my client has exhausted all measures to receive a decent
reply in this regard from the management of RELIGARE HEALTH
INSURANCE and it is primarily for this reason that my client is left
with no other option but to serve upon you this legal notice to
obtain some relief from her despair.
12. That my client has suffered a lot of inconvenience and mental
agony due to this unprofessional, negligent and lackadaisical
approach of Claims Department of you the noticee for which your
management are accountable wholly.
13. That this act has amounted to a deficiency in rendering
services, as defined in section 2(1)(g) of Consumer Protection
Act, 1986 which means ‘any fault, imperfection, shortcoming or
inadequacy in the quality, nature and manner of performance
which is required to be maintained by or under any law for the time
being in force or has been undertaken to be performed by a person
 in pursuance of a contract or otherwise in relation to any service’
along with indulgence in unfair trade practices.
14. That my client demands Rs. 200,000/- as damages along
with the total amount of bill i.e. Rs. 57445 with interest @ 18% per
annum paid by my client for her treatment to QRG Central Hospital
Faridabad, for the grave inconvenience and agony caused to her on
account of your careless conduct.
15. That my client further demands a written letter of apology
from the management concerned with Claims Department of you
the noticee.
16. That my client is also claiming Rs.11,000/- towards the
expenses of sending this notice.

That a reply to this notice is expected within 21 days from the date of
receipt of this legal notice failing which I have instructions from my client
to initiate legal proceedings against you in the appropriate court of law
and in that event you shall be accountable for all costs, risks and
responsibilities.

A copy of this legal notice is retained in my office for record and further
necessary action.

Sanket Chandila,
Advocate