[Resolved] Mediclaim Insurance — Insurance Claim - Wrongful Rejection by MD India - Oriental Insurance
Dear Sir / Madame,
Please find enclosed response as given by MD India herewith against my insurance claim for which I would like to complaint as follows.
As per hospital discharge summary, they have cited that current illness is present since last 12 years and hence the rejection.
This is not accurate according to me for following reasons;
(1) In year 2002 I had a Pulmonary Tuberculosis. At completely different part in body than what it is now. However same was treated for more than 9 months with Multi-drug combination therapy for Lung Tb, as evident from previous prescriptions. This proves the longer multi-drug treatment was taken (than WHO recommended standard of 6 month) and same should define this case as a cured TB. Hence there shouldn’t be any doubt retrospectively on the disease state.
(2) Since I have lived normal life all these years, as per immigration policy of France and UK we checked Chest X-ray in year 2009 and same was found to be normal. Test showed that I do not have active infectious TB in my body, moreso the clinic has given a certificate which was mandatory for its submission for granting the visa.
Also Montoux test was done on my hand in year 2010 (on self precautionary note at Prashant lab, Jalgaon) again test result came negative.
(3) My normal healthy living all these years and above two tests results confirmed that previously disease was cured beyond any clinical doubt.
(4) Moreover, renowned TB Physician Dr. Ashok Mahashur of Hinduja Hospital has seen case history and he has commented that he thinks it is newly contaminated infection and may be lack of body resistance have triggered latent TB into active form.
(5) It is very normal to get contaminated with NEW TB bacteria, particularly in highly endemic country such as India where no person can literally get shielded.
With given above facts and circumstantial checks that took place as to validate the past health condition, it is unconvincing that relapsed is due to past TB and hence the claim rejection by MD India should be condoned.
I find this is case of wrongly applying incontrovertibly doctrine Clause. 4.1 of MD India at their own behest as to come out with the self-benefiting outcome.
It is evident that even other medical opinion certainly disregard their reasoning on this claim and any subjectivity shouldn’t be linked whatsoever as a basis of rejection. I reiterate, TB is curable if proper medication has been taken and relapse causing because of it is bizarre, absurd and unfortunate logic.
Further, as per MD India’s own doctrine, we have still not received formal response of rejection and same procedural default by MD India holding us to appeal in this regard.
We are afraid MD India is exercising its overbearing on the case by not being logical and prompt and assertive enough and their intentions are in question as a basis of claim rejection.
For every count, I as a consumer is taking this behaviour very seriously and it goes beyond the notional value which to being involved.
With this email, I would like to elevate this to Oriental grievance redressal mechanism as to seek the intervention with sincere hope of fair treatment.
Mob # +[protected]
Complaint marked as Resolved 2020-08-14 04:09:10
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