[Resolved]  National Insurance Company — Non settlement of claim for reimbursement of medical expenses

Address:

Howrah, West Bengal, 711101

From :
Jyoti lall seal,
Seal’s lodge,
16/3, round tank lane,
Howrah – 711 101.
Mail. [protected]@gmail.com
Cell :[protected]/ land line :[protected].
_
Dear sir,

Sub. : non settlement of claim for reimbursement of medical expenses : regd. No. Ni[protected] : tpa id no. Gini[protected] : policy no. 101000/48/13/[protected].

This has reference to my claim towards treatment of coronary angioplasty which was undertaken in june, 2013 at the apollo gleneagles hospital at e m bye pass, kolkata. I had duly lodged my above claim to the designated tpa but yet to hear from them. Such silence is utterly surprising as considerable time has elapsed from my hospitalisation.

Prior to my angioplasty operation, i was admitted to mercy hospital, park street, kolkata as i had a sudden coronary attack at my work place which is situated at the next building of the said hospital. My colleagues immediately rushed me to the emergency department of mercy hospital and i was admitted then and there in the intensive cardiac care unit. As my condition worsened, i was relocated to apollo hospital where the above operation was performed. It may be noted that at the time of my admission, mercy hospital was not equipped with a cath-lab and other infrastructure for proper angioplasty/ angiogram operations. Due to the suddenness and the acute nature of my ailment, my colleagues were busy with my treatment and did not procure the emergency certificate from those hospitals. My tpa is trying to reject my claim in the garb of such minor deviation.

I would also like to mention that all the original documents duly verified by my employer, has already been submitted with my claim. The copy of the sanction made by my employer was also submitted. I had claimed only the unsanctioned portion of my claim which is detailed hereunder :

Date : amt. Claimed : amt. Sanctioned : amt. Disallowed :
18.05.2013 38, 276.00 21, 188.00 17, 088.00
06.06.2013 70, 282.00 37, 944.00 35, 338.00
27.06.2013 443, 480.00 183, 080.00 260, 400.00
22.07.2013 by ex-gratia 209, 361.00 (-) 209, 361.00
Total : 552, 038.00 448.573.00 103, 465.00

As the sanction of the balance of my claim is yet to be settled and is being unnecessarily delayed, i request to kindly look into the matter and issue suitable stricture to my tpa for an immediate settlement of my claim.

Thanking you in anticipation,

Yours faithfully,


Jyoti lall seal.