Bima Lokpal — declining of claim by sbi general insurance | |||
Dear sir/madam, My mother is holding health insurance policy no.[protected]-01 of sbi general insurance. My mother smt. Asha srivastava admitted in sanjay gandhi postgraduate institute of medical sciences lucknow at 04-dec-17. Insured was diagnosed with metastatic ftc. Sbi general insurance declined my claim no. 3762118 for policy no.[protected]-01. I would like to inform you that my claim declined on the basis of pre exiting criteria, where as suspected of metastatic ftc after mri report of dated 31/10/2017. You are requested to instruct concern to review claim decline decision (Mri report has already submitted). My patient has neither diagnosed any such type disease nor taken any medicine and never got medical advice for said disease. Why metastatic ftc is pre exiting disease? Please instruct concern to disclose my question. At the time of policy application we have clearly mentioned that our patient is diabetic and i could not hide any fact of disease of insured. Why is sbi general insurance declining my claim on basis of pre existing disease which did never exist earlier? My patient has never received any medical advice or treatment prior to enrollment in my medical insurance plan for this ailment. As you know, we have suffered a major loss that is having a big impact on our lives and we are struggling to recover. I have already emailed and telecom with sbi general insurance customer cares earlier but could not get reply/justification. I look forward to your response. Thank you for your anticipated cooperation in this matter. For reference i am enclosing herewith decline letter of sbi general insurance. Regards Piyush srivastava [protected] Was this information helpful? | |||
 2 Comments | |||
Comments
Hi, I am one of policy holder of health of other insurer, based on my experience, i am furnishing herewith some information, after going through denial of claim letter by the insurer it found to be claim denied due to pre existing condition & also there was a mention of previous claim which has been denied related to same condition. There are two aspects 1) Based on information furnished in proposal form 2) Based on discharge & treatment chart/report. Even though information furnished in the proposal form which was un connected in any way claim was denied based on available material facts, but insurer has not furnished what are material facts based. It is not enough to simply say preexisting based on material facts w/o any details, insurer has to furnish full details of material facts such as discharge or treatment report & any other previous medical reports. However you are entitled to refer the matter to sbi grievances cell & if no satisfactory response or not responded within 30 days from the dt of referring to gc you may approach insurance ombudsman within 12 months from the dt of response or no response for your grievance.
Reply
Lic maturity not received. My policy no
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