[Resolved]  Medi Assist India — denial of claim 94631277 under 070300/28/16/p1/11511126 silver_sez

Address:

691506

Subject: denial of claim 94631277 under 070300/28/16/p1/11511126_silver_sez

We refer to your claim submitted for reimbursement of hospitalisation expenses to medi assist insurance tpa pvt ltd. On scrutiny of the claim documents, we observe that the claim is not admissible in view of the following:

On perusal of the claim documents submitted, it is found that there is no hospitalisation / in - patient treatment. All bills / receipts enclosed are out-patient related. Therefore the claim is not admissible as per the clause mentioned above. Hence, we regret our inability to admit this liability under the present policy conditions.

The denial clause/s with description is/are reproduced below for your ready reference:

Clause description.
2.32 opd treatment:opd treatment is one in which the insured visits a clinic/hospital or associated facility like a consultation room for diagnosis and treatment based on the advice of medical a practitioner. The insured is not admitted as a day care or in-patient.

Since the claim does not fall within the purview of the policy terms conditions, we regret our inability to admit the claim. If you have any other information or documents to substantiate admissibility of the claim, please provide the same within 15 days of receipt of this letter.