Consumer
Sushil Wattal
(Querist) 09 May 2015
This query is : Resolved
i was admitted in hospital for more than 24 hours, all tests were done on the instructions of doctor, only diabetes and hypertension found. my mediclaim was rejected on the ground as per exclusion Clause 4.10. which read as fallows :- “Charges incurred at Hospital or Nursing Home primarily for diagnosis X-Ray or Laboratory Examinations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment of positive existence or presence of any ailment sickness or injury, for which confinement is required at a Hospital/nursing Home”.....Plz suggest how can i get my claim .. what grounds should i put in my complaint
Sudhir Kumar, Advocate
(Expert) 09 May 2015
you want a suggestion/advise from this forum without having seen your policy terms and conditions.
Dr J C Vashista
(Expert) 09 May 2015
Show the document/policy to a local lawyer for proper analyzing, evaluation, opinion, advise, guidance and proceeding.
Devajyoti Barman
(Expert) 09 May 2015
without seeing all papers it is not wise to make any comment here.
R.K Nanda
(Expert) 09 May 2015
agree with experts.
Rajendra K Goyal
(Expert) 09 May 2015
All the documents need to be referred, consult local lawyer.
Kumar Doab
(Expert) 09 May 2015
The case history,discharge summary will explain the symptoms noted at the time of admission.
Accordingly the doctor(s) will order tests to diagnose.YOu can ask the hospital to explain why the tests were conducted?
You may relate with these documents too.........while referring to T&C of the policy.
If unwarranted tests were conducted, it shall be the malpractice by hospital and your counsel may opine to claim from hospital.
If you are unable to handle on your own show all docs on record to am able Lawyer handling consumer cases......
T. Kalaiselvan, Advocate
(Expert) 09 May 2015
You said you were admitted to hospital for more than 24 hours, did you approach the hospital with a complaint or for general check up. However the Insurance company is right in rejecting the claim based on the clauses mentioned in your post.These tests are not included for medical insurance reimbursement scheme, if you are dissatisfied with the reply, you may consult a local lawyer for legal actions if any would bring a solution.
