Mediclaim reimbursement not given
VINOD KUMAR JOSHI
(Querist) 27 April 2014
This query is : Resolved
Dear Sir,
I have National insurance mediclaim policy for my family members individually.
My wife was expire due to dengu syndrome shock at fortis hospital on sept.-2013. TPA of insurance co. denying to my balance claim for Rs. 21,163/-
In this regard I have received park mediclaim consent letter for Rs.660/- instead of Rs. 21,163/-. An amount of Rs. 20,503/- disallowed due to maximum limit for medicines & investigation 50% of S.I. has exhausted.
In this regard I would like to mention that total sum insured amount included bonus etc is Rs.2,88,750/- but total claim amount submited to you is less than the sum insured.
An attachment is also enclosed for your reference. please guide me shall I recover my claim from insurance co.
Devajyoti Barman
(Expert) 27 April 2014
Policy papers needs to be seen. In nay case you can file case in consumer forum to see if you get more.
Kumar Doab
(Expert) 27 April 2014
Show the policy document to your lawyer.
IN the same year have you filed other claims too?
If NO how can SA of Rs.288750/- (50% of which is Rs.144375/-) is exhausted?
Lodge a complaint direct with MD/CEO of the company in writing under proper acknowledgment.
Rajendra K Goyal
(Expert) 27 April 2014
Consult a local lawyer and show him all the documents.
