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Health & Life Insurance

Claim not settled by the insurance company

Complaint Details: 
I am a health insurance policy holder with Max Bupa health services with the customer id: 0000097938 and policy number: 30081516201200. I had filed a claim (cpatient name: Vivaan Dassani, Hospital: MERF, Chennai) with the company on 18.06.2012 Claim no. 12741 for my son's surgery submitting my original documents and the documents as required by the company in their prescribed formats and formalities were done to the fullest including handing over xerox copies of the original bills to their field investigators. I have been calling them again and again from the past 2 months and they are not responding to settle my claim by any sense, giving excuses everytime. Now they have started a new thing telling me to get some reports from the hospital which is the job of the health insurance company to obtain. I got them linked up with the concerned person in the hospital and even after that they are unable to process this claim. At the time of selling the policy they show us an elephant and give us not even an ant when we file a claim. I took this policy from their employee named Mr. Nirmal Shrivastava mobile no. 8860967897 and he told me that everything in emergency is COVERED FROM DAY ONE. Now when I have filed a claim of my Son's emergency surgery, they are refusing to settle the claim asking me to submit these documents on their part. I JUST HAVE ONE QUESTION, WHY DOES MAX BUPA EVEN EXIST WHEN WE HAVE TO GET ALL THE DOCUMENTS EVEN AFTER SUBMITTING THEM THEIR REQD DOCUMENTS? THEY ARE JUST ONE OF THE BIGGEST DUPER'S WHO ARE NOW NOT EVEN RETURNING MY SON'S SURGERY ORIGINAL DOCUMENTS WHICH I NEED URGENTLY. I will be more than happy to file a legal case against the company as well if they are not reimbursing the money as they are now just harrasing me. PLEASE GUIDE.
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