[Resolved]  Medi Assist India Pvt Ltd — Denial of the Claim

Hello,

I am working with Wipro Technologies, Hyderabad and have taken parental insurance for my Father through ICICI LOMBARD. Policy details are as follows
Policy Certificate No Cover Period from Cover period to Type of cover
4015/0001657/01//12606 1-May-08 30-Nov-08 Comprehensive
4015/0001014/03/2046 1-Dec-08 30-Nov-09 Standard
4015/0001014/04/0891 1-Dec-09 30-Nov-10 Standard

My father has undergone cataract surgery on 23rd April 2010 and Iraised calim with TPA Medi Assist. This claim is denied, with the following reason "The insurance incepts from 01/05/2008 and the patient was admitted to the Hospital on 21/04/2010 for the treatment of Cataract. As per treating doctor certificate, the patient is suffering from cataract for the last 2 years. Going by the duration of ailment and taking into account the date of inception of Insurance, the ailment is pre-existing. Hence the claim is not admissible under the policy and stand repudiated under the exclusion clause no. 3(i)of the mediclaim policy.".


I believe ,that the statement that cataract is existing for the last 2 years in the Doctors certificate, which is very generic in nature, can not be taken as reason for the denial of the claim. As we all know, though cataract exist for last 2 years, it is the Doctor we decide when this need to be operated. This is not the case, when some one got some accident on a particular day, with evidence available.

I request your guidance in selling this claim.

Regards,
Ramachandra Murthy Gunturi