[Resolved]  Apollo Munich Health Insurance — cancellation of medical policy by appollo munich- pol. no. 170400/11051/aa[protected]

Address:

Bhopal, Madhya Pradesh, 462047

Dear sir,

I, the undersigned, Sunil Mathew (Age 43) the medical policyholder for self and family from Appollo Munich, would like to bring the following facts for your kind consideration.

1. I had taken the policy for my family and me from Apollo Munich from February 2015 onwards which has been renewed from time to time.

2. On 12/03/2018 my wife Mrs. Shiji Sunil Mathew was admitted to Bansal hospital at Bhopal for treatment on acute abdominal pain and vomiting. She was operated on 14/03/2018 after the diagnosis of Tubal Ectopic pregnancy and was discharged on 16/03/2018.

3. As per the terms and conditions of the policy I requested the hospital authorities to apply for cashless facility and accordingly the hospital submitted the claim to the insurance company.

4. On this I received communication from the insurance company on 13/03/2018, indicating that the cashless facility cannot be granted due to non-disclosure of material facts (Carcinoma breast prior to policy period).

5. Further, I received a communication from insurance company giving notice of 30 days for termination of policy on the ground of non submission of material facts (carcinoma in the breast 18 years back), for which I had replied to the Insurance company on 19/03/2018 stating that there was no carcinoma, and the hospital doctor had inadvertently written on the admission sheet of patient about the illness (which was not correct). The letter written by the hospital doctor Priya Bhave Chittarwar which is explaining the fact is attached herewith for your reference.

6. In the meantime I fully paid the hospital payments and applied the company for reimbursement of the hospital bills, amount of Rs. 97861.00 at the time of discharge.

7. On receipt of my claim for reimbursement the insurance company deputed their doctor at our residence for further check up and to verify the facts. He submitted report to them and we got the reimbursement of the claim on 18 April 2018, amount of 87607.00, which means the policy was in vogue and the claim was rightly settled.

8. Later on 18/06/2018, i.e. after 3 months, I received communication from the insurance company indicating that they had terminated the policy on the ground of non-disclosure of material facts. In this condition I had written to the company on many occasions, explaining the facts that there was no case of Carcinoma in the past and the comments were inadvertently written on the case paper. This fact has already accepted by the senior doctor of the hospital who is HOD, in her letter.

The company has not taken heed to my repeated requests for continuing the policy, and has discontinued the same.

From the above facts it is clear that there was no case of non-submission of material facts at the time of taking the policy on my side. Further I am willing to undertake any medical checkup of my wife at any reputed hospital (which is on the panel of insurance company in Bhopal) for their confirmation. I also declare that my wife had no carcinoma in the past and the comments of the hospital are wrongly mentioned (for which they have already clarified).

I, therefore request you to kindly intervene in the matter and instruct the insurance company to reconsider my case and reinstate the policy at the earliest.

Sir, I am sure that after studying my case you will certainly do the justice and do the needful in this regard.

With warm regards and good wishes

Yours faithfully

Sunil Mathew

Encl: 1. mail from Apollo munich- notice for termination

2. My reply to the company

3. Letter of doctor clarifying the mistake done adverting /

4. mail of company claim reimbursement
5. Termination of policy letter by the company