[Resolved]  Lic Of India — rejection of claim..

Address:

Jhajjar, Haryana

The Chairman
LIC of India
Mumbai
Maharashtra

Ref: Policy No.[protected]; Insured Member: Rajan Chaudhary
Claim Intimation no: 11000781 dated 08.12.2011 of TPA: E-Meditek(TPA) Services P Ltd

Dear Sir,

With ref to above mentioned policy, we have received your reply regarding rejection of our request
for the payment of Hospitalization and Surgical Benefits.

In letter you have mentioned that you are not considering our request due to following reasons: -

Repudiation Code: L 08 – Total Hospitalization period less than 52 HRS

In Policy minimum hospitalization hours is Mentioned as 48 HRS inspite of 52 HRS.

Repudiation Code: L 10 – Claim form not received with all relevant documents of treatment
taken.

We have already sent the claim form and relevant documents. In case more documents are required
by you with any other form, please let us know so that we can send other documents.

Repudiation Code: M 01 – Surgery not Listed in the allowed surgeries as per policy conditions.

At the time of issue of Policy we have told that this is a normal Medi-Claim Policy and all type of
Injuries and Surgeries are covered in this Policy. Now when we are applying for the claim you are
rejecting our application saying that this surgery is not listed as per policy. We went to Local Office
of LIC at Bahadurgarh. Head of the Office is also unaware about such clause in the Policy. This is
Completely Unfair with the Public.

So we are requesting you to reconsider our application. Otherwise I ll file a complaint with IRDA
(Insurance Regulatory and Development Authority)

Thanking You

Yours Faithfully