Fwd: Fw: Denial of claim 16995530 under 5001002817P112054746

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Shrinivas Parkar

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Jul 17, 2018, 12:17:51 AM7/17/18
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My genuine claim has been rejected by the United India Insurance Company on flimsy ground. What can be done in such cases?



UNITED INDIA INSURANCE CO. LTD (A Government Of India Enterprise)CIN: U93090TN1938GOI000108IBA CELL(Ground Floor, Vulcan Insurance Building, 77, Veer Nariman Road, MUMBAI 400 020)Tel. No. 022-22822564/564 Fax No: 22820521

Date :12/07/2018                                               

To,BANK OF INDIAShrinivas ParkarSTAR HOUSE C - 5, MumbaiMumbai-400051

Claim under Policy No.

: 5001002817P112054746

Name of the Insured

: BANK OF INDIA

Name of the Insured Person

: Shrinivas Parkar

Relationship

: Self

Claimed Amount

: 35397

Claimed for

: Shrinivas Parkar

Hospital Name

: Sreedhareeyam Ayurvedic Eye Hospital And Resarch Center

Claim ID

: 16995530

Employee ID

: 118614

Date of Admission

: 4/26/2018

Received Date

: 5/14/2018 8:35:06 PM

Relation

: Self

Diagnosis / Type of Treatment

: Drushti gatha rogam

 

Dear Mr/Ms

We regret to inform you that your claim could not be considered for payment due to the following reasons and stands as repudiated:

Policy Condition No. With description :4.7 : 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 of presence of any ailment, sickness or injury, for which confinement is required at a Hospital / Nursing Home, unless recommended by the attending doctor.
Detailed Narration :Shrinivas Parkar was admitted at Sreedhareeyam Ayurvedic Eye Hospital and Resarch Center on 26 Apr 2018 for Drushti gatha rogam and discharged on 04 May 2018. As per documents available which treatment has been given during hospialization that could be manage on opd basis also. Hospitalization is not justified, hence claim is rejected under clause 4.7.

The original claim papers are retained by TPA M/s. Dedicated Healthcare Services TPA (INDIA) Pvt. Ltd.  In case you need any clarification / assistance in this regard, please contact the TPA at their email id cont...@dhs-india.com Or their 24 X 7 Toll Free No. 02266275900.  On all communications please refer your above mentioned claim id.

Thanking you and assuring you of your best attention.

Yours Sincerely,

Authorized Signatory.B. D. PETKARINCHARGE, IBA CELL

In case you are dissatisfied with our decision even after your request of reconsideration of the claim, you may approach the insurance ombudsman office in your territory.

Corporate & Head Office : 24, Whites Road, Chennai – 600 014. www.uiic.co.in

 


Manish Pandey

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Jul 17, 2018, 6:22:36 AM7/17/18
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Go to court from lower court to Apex court

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pady nabs

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Jul 17, 2018, 6:22:36 AM7/17/18
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you please send a cop y to your association and aibrf.     If your hospitalisation bill are well within the purview of the agreement between insurance company and bank, union will take up the matter.


padmanabhan. s

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bhaskara sarma

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Jul 17, 2018, 6:22:36 AM7/17/18
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Treatment charges in Ayurvedic and Naturopathy hospitals are not reimbursed.It is waste of time.The Insurance policy is devised in such a way it promotes corrupt, inefficient and costly Allopathic treatment only.
P Bhaskara Sarma.

Anil Verma

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Jul 18, 2018, 12:12:22 AM7/18/18
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Please note TPA cannot reject the claim out rightly. The letter you have got for rejection of your claim is on the recommendations of TPA.
First of all go through the policy document throughly and see if the claim being made by the company is in order. Then you can represent the same through nodal officer of your bank who is there to take up your case with insurance company. As a matter of fact before rejection of claim a tripartite meeting should have been arranged or fixed between bank, TPA and insurance company to sort out the issues pertaining to your claim but I am sure no such procedure has been followed in your case. Now you have to exhaust all the channels before taking any legal action. 
First of all take up your issues with nodal officer mediclaim of your bank and request him to help you out in the matter by calling all the papers through TPA and resolve the issue in consultation with insurance company by calling a meeting in his office. If it is not resolved then follow the required process as explained on IRDA website. 
Please create written record of every action you take in the matter. Make all correspondence electronically and should have kept copies of all papers submitted to TPA for your records.
It is a comman practice by all TPA'S of such harresment and they don't want to pay the claim. 
You should exclate the issue through  IRDA, TPA & UIIC website complaint mechanism whole process is explained on IRDA website. 


On Tue, 17 Jul 2018 15:56 'pady nabs' via bankpensioner, <bankpe...@googlegroups.com> wrote:
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you please send a cop y to your association and aibrf.     If your hospitalisation bill are well within the purview of the agreement between insurance company and bank, union will take up the matter.


padmanabhan. s

On Tuesday, 17 July, 2018, 9:47:55 AM IST, Shrinivas Parkar <sppar...@gmail.com> wrote:


My genuine claim has been rejected by the United India Insurance Company on flimsy ground. What can be done in such cases?


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Shrinivas Parkar

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Jul 18, 2018, 12:12:29 AM7/18/18
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Thank you Mr. Padmanabhan. I will send copy to AIBRF, as per your advise.

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Shrinivas Parkar

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Jul 18, 2018, 6:11:02 AM7/18/18
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In the year 2016, they had paid the claim for same treatment in same hospital. At that time also, they had asked justification for Hospitalization. When I submitted certificate from the Hospital justifying hospitalization, they paid my claim 
This time also I have submitted the attached certificate from Hospital that hospitalization was recommended by the attending Doctor and it was necessary. 
Members are requested to guide me.


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