Oriental Insurance Company — POLICY NO. 171102/48/2015/10272 / CLAIM NO. [protected] / MEMBER ID:[protected]

Address:

Vadodara, Gujarat

Dear Sir, Ref ID: CLAIM NO. [protected] / MEMBER ID:[protected] My name is Kamlesh Parekh having above policy, before 2 months i had filed reimbursement for Rs.32916/- as i was hospitalized from 17/04/2015 to 25/04/2015 at Gujarat Cancer & Research institute, Civil hospital, Ahmedabad for surgery affected by carcinoma. Yesterday i have recd a mail-letter from agent as stated that it was non payable - rejected, reason is clause 4.8 chewing of tobacco, betel nut as a habitant etc., pls. see below my reply to you for approval of said claim as genuine reason: My self wanted Raksha TPA to understand the background of my case that clearly indicates that i am not a user of tobacco however doctor with some misunderstandings mentioned tobacco usage in the consulting letter which we have cleared as untrue in every stage of the procedures. I would want to mention that i was just used simple pan normal ocassionaly (which is stated unharmful). With reference to clause no.4.8, you had rejected my mediclaim which do not apply to my case. Moreover, If tobacco did cause Ca, why there are so many people dead or alive who never had Ca after the use of tobacco? Whether tobacco is the only cause for Ca ? Why Ca is seen in people with no history o[censored]se of tobacco? In other words the other causes of Ca such as a 'Sharp tooth', Bad oral hygiene, heriditary factors and food items which can cause a cancer so much so the cause of cancer has not been fully established as yet. There are only some associations that's all. Tobacco chewing is not the only cause of cancer. Squamous cell Ca of tongue has been seen even in patients who never used any form of tobacco. What medical reasearch says is that there is association between any form of cancer and the use of tobacco so much so that a cause and effect relationship can be attributed to the use of tobacco and cancer. Coming to the law point, The date of operation is between 17/04/2015 and 25/04/2015. Now what is the contention of your responsibility, whether it says that there was no cancer at the time of issuing the policy and it appeared only after that date? I mean to say that cancer could have been in the initial stage even at the time of issuing the policy which no one can ascertain now by any stretch of imagination. What does the insurance company say about the smoking habit of its insured at the time of issuing the policy? Did it gave the policy to a person who is predisposed to cancer? Even in such situation the onus of proving the clause " use of tobacco has lead to this cancer in this particular person" squarely lies with the company which is highly impossible for them. In addition to, you can never reject 100% amount without consent of me as you can also welcome to my home for any verification, documents, meetings if any that you required further, my self is also and advocate of high court, pls. look into the matter seriously and process my claim asap otherwise i can also file serious case against your company for this reimbursement, compensation of harassment and 18 % interest value. Summarily, pls. look into this matter and do the needful as I had submitted only Rs. 32916 /- and it is not big amount for this type of disease, it is very very genuine amount to be passed.