[Resolved]  Oriental Insurance — no claim

Address:

Mehsana, Gujarat

I take a insurance last 10 years in insurance company but they do not pay a claim amount last year in 2010 11 claim number in e-meditek tpa is 903654 i add all detail bellow.



Regional Office (ahmedabad) Sakar-5, 7th Floor, 709, Behind Natraj Cinema, Near Gandhigram, Railway Station,
Ahmedabad - 380009, Gujarat
Phone No :[protected], Fax No :[protected],
EMail : [protected]@emeditek.com
REPUDIATION LETTER
WITHOUT PREJUDICE
Date : Jan 25, 2011
The Oriental Insurance Company Limited
Relief Market, Near Vepari Gin,
Kalol - 382721,
Gujarat
Sir / Madam ,
Reg:
Hospitalization claim of : Shardaben K Patel
Employee Name : Kanubhai C Patel
Employee Number : - Na -
Hospitalization Period : Dec 20, 2010 - Dec 25, 2010
Hospitalization At : Devasya Hospital
Diagnosis : Adpkd + End Stage Renal Disease
Our reference No : OI/INDO/12011/00903654
Policy Number : 143601/48/2010/3602
Repudiation Letter No. : EMSL/REJ/12011/00108719
We are in receipt of the claim form & associated documents of Shardaben K Patel. On scrutiny of the same, we observe that he / she was admitted in Devasya Hospital. patient was admitted with c/o dyspnoea, pedal oedema and bilateral renal crepittation. DX as ADPKD + END STAGE RENAL DISEASE patient was operated for left radiocephalic fistula at wrist at nail hospital. hemodialysis done in devasya hospital. ADPKD [Autosomal Dominant Polycystic Kidney Disease] is genetic disease so this claim is not payable as CLAUSE 4.15 Genetical disorders and stem cell implantation / surgery..
In view of the above, we are left with no option but to repudiate your claim .
We regret the inconvenience caused and view this as an opportunity lost to be of service to you.

Yours Sincerely,
For E-Meditek (TPA) Services Limited
Dr. Hitesh Patel
CC :
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