Life Insurance Corporation of India [LIC] — i am complaining about my sickness benefit under ashadeep policy no. g[protected] in favour of dr uma sankar patro

Address:

Khordha, Odisha

Refused my sickness benefit claims under ashadeep lic policy g[protected] of dr uma sankar patro indicating that ptca operation is not covered under ashadeep policy. I was undergone non-surgical procedure ptca + stenting to my heart disease on[protected] at aditya care hospital, bhubaneswar, odisha. Let me know how ptca is not be considered?
Sub: request to consider and settle the sickness benefit under the policy asha deep, policy no. G[protected] of dr. Uma sankar patro
Sir,
With due respect i dr. Umasankar patro a asha deep policy holder policy no.: g[protected] beg to state that the date of maturity of above policy was 28/11/2018 for which referring to lic sambalpur branch-ii office letter 5004/ claims/maturity benefit dated 31/08/2018, wherein i have also submitted the following all documents in original hard copies as per their requirement by speed post dated 10/10/2018 for settlement of the said policy and once again the support documents like scan copies in the prescribed claim form: ad (Cabg)-1 provided by the lic sambalpur branch-ii office (Cabg claim under asha deep policy). Wherein, the medical surgeon certificate in original, ptca report and other related photo copies in support to my treatment in 29 pages. Those soft copies were also sent through e-mail to [protected]@licindia.com with a copy to [protected]@licindia.com, [protected]@licindia.com and [protected]@licindia.com to settle final maturity and sickness benefit under my asha deep policy g[protected]. Where i have also submitted the scan copy (Soft) of the policy bond g[protected] because in their letter they have not mentioned anywhere to submit in original for settlement of maturity benefit.
I have submitted the documents related to my treatment at aditya care hpspital, bhubaneswar against “heart disease” e. G diabetes mellitus, hypertension, chronic stable angina, tmt +ve, good lv systolic function where the angiogram report was:
· lad shows: type iii vessel, 80-90% stenosis at mid segment (Blockage),
· cath diagnosis: cad-lad-90%, om-40% plvb (Rca)-70%, coronary cemaral fistula from lca to pa.
· cath advice was #ptca + stenting to mid lad and medical management to continue.
· ptca report was:
· indication : chronic stable angina
· lesion : mid lad
· result : satisfactory
· post ptca vessel status : timi iii flow, no residual lesions
· complication : nil
Angiogram:
· a coronary angiogram is a procedure that uses x-ray imaging to see your heart’s blood vessels. The test is generally done to see if there’s restriction in blood flow going to heart. Coronary angiograms are part of general group of procedures known as heart (Cardiac) catheterizations. Cardiac catheterization procedures can both diagnose and treat heart and blood vessel conditions. Dye will be injected into the body (Heart) to highlight blood flow through the arteries. This helps to see any blockages in the blood vessels that lead to heart.
Ptca :
· (Percutaneous transluminal coronary angioplasty is a minimally invasive procedure to open up block coronary arteries, allowing blood circulate un-obstructed to the heart muscle. …. Next, a long narrow tube called diagnostic catheter is advanced through the introducer over the guide wire, in to the blood vessel.
· “baloon angioplasty of the coronary artery, or percutaneous transluminal coronary angioplasty, was introduced in the late 1970’s. Ptca is a non-surgical procedure that relieves narrowing or blocking and obstruction of the arteries to the muscle of the heart (Coronary arteries)”
Stenting:
· a coronary artery stent is a small, metal mesh tube that expands inside a coronary artery. A stent is often placed during or immediately after angioplasty. It helps prevent the artery from closing up again. A drug-eluting stent has medicine embedded in it helps prevent the artery from closing in the long term.

It is here to inform you that i was undergone my above treatment on 24th october 2015. I have requested to release the medi-claim benefit on 25.11.2015 and the claim form with other related papers were submitted to the lic, sambalpur in the year 2016 referring to their letter sd/claims/sbo ii-17 dated 12.07.2016 of divisional office by hand but it is unfortunate to indicate here that they have not taken any steps towards the settlement of my sickness benefit under asha deep and on enquiry it was learnt that those documents were missed in their office and once again those were submitted as mentioned above on 10th october 2018 through speed post and e-mail. The original policy was submitted on 14th january 2019 for early settlement.
On so many requests through e-mail and over telephone the matter was taken to the claims department of lic; on 22.10.2018 vide their ref. Letter no. Sbo ii/5004/claims. Now vide their ref. Letter no. Sbo ii/5004/claims/aao dated. 20.12.2018 the branch manager lic sambalpur branch office-ii sambalpur has intimated that the claim was referred to their divisional office, claims department for consideration. On reply vide ref. Sd/claims/ dated. 13.12.2018 of divisional office. “jeevan prakash” they have replied that “as per the advise of our dmr, the operation (Ptca) is not covered under the asha deep sickness benefit claim. Hence we are returning herewith the documents 29 pages that you have submitted at our end”.
It is here to mentioned that due to late in taking the final decision on sickness benefit under operation (Ptca) of self for heart disease under the said asha deep policy the settlement of maturity benefit is also laying delayed at their end for which i am loosing the interest on my financial benefits since from 28/11/2018 till the date of final settlement. Hence i am hereby claiming the said interests to be awarded to me at time of the settlement.

The documents and information submitted by me earlier are as bellows;
1. A dully field format covering 11 points as per you have mentioned
2. Self attested photo copy of aadhaar card
3. Self attested photo copy of pan card
4. Cancelled cheque leaf where the account holder is mentioned
5. Photo copy of first page of the bank pass book with the name, account number, ifc code etc.
6. Original money receipt for rs. 1, 17, 498.00 (Rupees one lakh seventeen thousand four hundred ninety eight) only with a detailed statement affixed with a revenue stamp of re. 1 along with self and two gazetted officers signature with seal in original as per your format.
7. Request letter to settle the claim,
8. Photo copy of letter no. Sd/claims/sbo ii-17
9. Photo copy of cbga claim under asha deep policy no. G[protected] pages)
10. Photo copy of ptca report (2 pages)
11. Photo copy of echo cardiographic report
12. Photo copy of discharge summery etc.

It is here to mention that once again the crm sambalpur, lic of india was requested to reconsider my case under sickness benefits on 3rd january 2019 through e-mail and was also sent to claims. [protected]@licindia.com for consideration. But till yet no communications have been received from them.

Prayer :
Ptca :
· (Percutaneous transluminal coronary angioplasty) is a minimally invasive procedure to open up block coronary arteries, allowing blood circulate un-obstructed to the heart muscle. …. Next, a long narrow tube called diagnostic catheter is advanced through the introducer over the guide wire, in to the blood vessel.
· “baloon angioplasty of the coronary artery, or percutaneous transluminal coronary angioplasty, was introduced in the late 1970’s. Ptca is a non-surgical procedure that relieves narrowing or blocking and obstruction of the arteries to the muscle of the heart (Coronary arteries)”
Stenting:
· a coronary artery stent is a small, metal mesh tube that expands inside a coronary artery. A stent is often placed during or immediately after angioplasty. It helps prevent the artery from closing up again. A drug-eluting stent has medicine embedded in it helps prevent the artery from closing in the long term.

From the above ptca is one of the non-surgical procedure that relieves narrowing or blocking and obstruction of the arteries to the muscle of the heart (Coronary arteries)
A stent is often placed during or immediately after angioplasty. It helps prevent the artery from closing up again. A drug-eluting stent has medicine embedded in it helps prevent the artery from closing in the long term.
· hence i would therefore request to consider my heart disease treatment under ptca (Percutaneous transluminal coronary angioplasty) a non-surgical procedure that relieves narrowing or blocking and obstruction of the arteries to the muscle of the heart (Coronary arteries)
· and necessary orders may be passed to the divisional office, “ jeevan prakash” ainthapali sambalpur-768004 and manager claims department to settle the sickness benefit and maturity benefit along with interest under asha deep policy g[protected] in favour of dr. Uma sankar patro.

This is for your kind information and necessary action.
With regards yours faithfully