[Resolved]  Reliance General Insurance / Medi Assist India Pvt Ltd — Mediclaim Settlement

Address:

Vadodara, Gujarat

From : Mitesh B. Bhatt
C-1/5,Mahavirnagar Appt
Nr. Hariomnagar Bus Stop
Opp.Subhanpura Water Tank
Atmajyoti Ashram Road
Vadodara- 390023
Dated:3/5/2011
To,
The Manager
Medi Assist India Pvt Ltd
701, Kaivanna Building
Beside Ahmedabad Central Mall
Nr. Panchavati Circle
Ellisbridge, Ahmedabad – 380 006

Sub : Medical Reimbursement Claim – to be reviewed and reopened.
Ref : 1. Policy No : [protected]
2. Claim No: 5780041
3 Email dated :[protected]Copy attached)
Sir,

I was surprised to get an email mentioned above, rejecting my claim for the re-imbursement of the medical expenses incurred towards the treatment of my wife Mrs. Naimesha M. Bhatt. I was not formally informed by TPA or Reliance General Insurance Company till today. It is because of my follow up and perusal I could get the e-mail stated above.

I understand that my claim which is very genuine and original has been rejected on the basis of “False Statement” and “Duty of Disclosure” as per personal investigation and report by Dr. Bimal Desai of your Company.

I had taken my wife to Chandan Hospital. Vadodara on 1/2/2011 and she was diagnosed and treated by the Dr. Prakash M. Shah on an OPD basis. We were also not prepared to immediately admit at the Hospital (when told to do so) as it was not anticipated even though Doctor advised. However, after taking the Preliminary Medicines and treatment on OPD basis on 1-2-2011 as advised by Doctor of Chandan Hospital, Vadodara, I admitted my wife to the hospital the very next day i.e. on 2-2-2011 and treatment continued upto[protected]. It may be noted that my wife Mrs. Naimisha M. Bhatt was is an ordinary citizen who does not understand any medical terminology and do not have any medical knowledge. When she was asked the questions as the part of the investigation by Dr. Bimal Desai, my wife stated the reason for weakness due to Viral Hepiatities with Jaundice which was diagnosed by Dr. Prakash M. Shah, M.D Physician, Vadodara After investigation, Dr. Desai asked for indoor case paper (ICP) and job attendance certificate from the organization where my wife is serving. These documents and certificates were sent to Dr. Desai by Registered Post.

“Normally any patient, who may be very serious would not have prepared to admit the hospital immediately on advice, as they would not have mentally and financially prepared for the same. This is a natural fact which a common man can understand. However, on the basis this reason the company has straight away rejected my claim for reimbursement which is not prudent and against the natural justice. Please note that I have not claimed any bill for the treatment incurred on 1-2-2011. (Doctor’s Clarification Certificate is Enclosed).

I enclose the Clarification certificate issued by Dr. Prakash M. Shah, M.D General Physician, Chandan Hospital & ICU, Vadodara for your ready reference after getting the information that my claim for sanction has been rejected through the Email on[protected] based on the investigations and report by Dr. Bimal Desai. I have personally collected the report from Branch Manager, Reliance Insurance Company, Vadodara on 2-5-2011.

On the basis of the certificate issued by the Doctor and on the basis of the above stated facts, I once again request you to re-open my case and sanction the reimbursement amount with immediate effect.

Your immediate action is anticipated failing which I will be forced to take legal action against you.
Yours Faithfully

(Mitesh Bhatt)

Encl :1. Copy of Clarification Certificate by the Dr. Prakash M. Shah.
2. Email Copy of inability to admit liability
3. Report Copy of Dr. Bimal Desai

Copy f.w.cs to :
1. The Branch Manager
Reliance General Insurance
Vadodara

2. The Officer
Medi Assis India TPS Pvt. Ltd
Bangalore