National Insurance Company Ltd. — Non payment of claims

Address:

700071,

From Sri Swapan Kumar Halder,
H/o Smt. Manjulika Halder
5/1, Gangaram Pal Road,
P.O. Naihati
Dist. North 24 Parganas
West Bengal
Pin.743165
Mo.[protected]
To
The Chairman And Managing Director
National Insurance Company Ltd.
3, Middleton Street, Midleton Row,
Prafulla Chandra Sen Sarani
Kolkata - 700071,


Sub. Harassment, negative motivation, vindictive attitude
Of the Branch Manager, National Insurance Co.
Ltd., Barrackpore Branch, in reimbursement Of
balance Rs.42000.00 intervention request of
Ref. 1) policy no:-[protected]
2) Baroda Health Smt, Manjulika HalderW/O Swapan
Kumar Halder Card No.[protected]c
3) Date of admission 20/06/2014 date of discharged
02/07/2014 to enlisted Nursing Home Care & Cure
4) Email from Sujit.[protected]@nic.co.in Date: Thu, Feb 25, 2016 at 7:45 PM inresponce of my Email from
[protected]@gmail.com
Sir,
With due honour I lay before you the following facts for your kind intervention so
that senior citizen 72 years of old client do not harassed by the Branch Manager
Barrackpore while claimed the actual expenses paid to the Nursing Home arising out of
a special and isolated case to survive the critical patient from death
1. On emergency ground my wife was admitted to Care & Cure Hospital for operation
Of acute Gallbladder on cashless basis, as per contract with the TPA and it
was assumed that laparoscopy Operation will be sufficient to eliminate and
erect the said gallbladder.
2. AS such the rate was as fixed per Pkg. provided by the Insurance Company under
GIPSA PPN
3. AS stated by the Doctor that On operation Table during laparoscopic
operation when camera was Inserted it was seen that pt .had Myrizl
Syndrome, Bile duct having same wall- during dissection Bile duct had
a tear –Exploratory laparotomy done-had to undergo Cholecystectomy
with Billary By Pass and she had stormy postoperative period –needed
ICU Treatment and she got extreme higher antibiotic for the development
of early ARDS
4 In this situation the condition of the patient became very serious and critical
having no other alternate the consultant Surgeon taken spot decision as mentioned
above Ref.3 otherwise the patient will not be survived.
5 For the above mention situations the Doctor has given appropriate certificate
which was submitted accordingly.
6 On discharged The National Insurance Company Ltd refused to pay full
Amount on the ground that Hospital cannot be charged higher than the pkg.
(as per GIPSA pkg. already given at the time of cashless claim) hence excess
amount of pkg. not payable as per Ref.4) and instead of Rs.65100.00 paid
only Rs. .23000.00 I have paid Balance excess Amount Rs.42100.00.
7 It is not understood why due to the laps on the part of your management and the
agreement between the Hospital why I am to suffer, if needed you may please cancel
the appellation of the hospital so that patient do not suffer.
In this situation I would request you to pay Rs.42100.00 at the earliest to avoid any
Future discrepancies and to restraint me to seek legal help.
Trust, this will find your favourable consideration.
Thanking you,
Dated 01.03.2016 Yours faithfully,

(SWAPAN KUMAR HALDER)