National Insurance Company — policy number :[protected]

Greetings!!!

Reference your letter no. 20rb01naa0686 dated 26 june, 2019

Policy number :[protected]

Claim ack number :ack[protected] dated 29.05.2019.

With utter shock and disbelief i am writing this mail to you.

I have just now received your company letter no. 20rb01naa0686 dated 26 june, 2019 intimating that my claim for policy number[protected] for rs. 31, 881/- has been approved for rs. 11, 493/- only. The letter also gives reference of some letter dated 15 june, 2019 purported be written by your company to me that i need to provide original cheque to enable your company to remit funds to my account.

While i acknowledge part of your communication (S) to be true, i am shocked to receive above letter which contains whole bunch of lies probably with the intention to deny my lawful claim. The facts of the case are as under:

1. I had submitted my claim on 29 may, 2019 through my insurance advisor as i was unable to move because of my immobility due to plastered leg. Ack of the same was provided by your office.

2. As there was no communication from your office i requested my insurance advisor to follow up. At that stage i was verbally informed through her that following original documents were required by your office:

A) echo report with film,
B) ankle/leg report.
C) ecg graph
D) original prescription from doctor dated 07 & 08 may 2019.

3. Please note that all these follow up were through the insurance advisor who had been taking all pains to be a bridge between insurer & tpa. My complements to her. There has not been any communication from your office as mentioned in your letter under reference.

4 i was informed verbally through insurance advisor on 13 june, 2019 that some papers were not found in the claim submitted by me. I intimated her that all original documents were submitted along with claim documents. I sent a letter through insurance advisor intimating that all documents have been submitted to your office along with claim form. I was informed over telephone that some original documents amounting to about rs. 5, 000/- (Approx), were not available in records. I was then provided with your contact number and email id. On my call, you confirmed that some original reports were not traceable and i need to write you a mail that deductions towards documents not traceable may be effected. As this was to facilitate my faster claim settlement and my inability to move and check the records, i sent the confirmatory mail to you in good faith with the clear understanding that rs. 5, 000/- (Approx) will be deducted from my claim. The contents of my mail sent by me are as under:

Quote "i had undergone surgery for ta repairs at fortis hospital. Bills for subsequent domiciliary treatment were submitted and acknowledged vide receipt number
Ack[protected] dated 29.05.2019.

I am informed that some of the bills/reports are not available on records submitted by me.

As discussed, i am not in a position to move due to surgery and old age, i authorise you to deduct related bills and clear bills at the earliest. I urgently need funds to continue my treatment". Unquote

In response to my above mail, i got the following mail from your office on 14 june, 2019.

Quote "your case has been medically approved & is in further process."unquote

While i was expecting credit of claim i was once again verbally communicated through my insurance advisor that i need to give an affidavit that capt. S. N. Suri and surendra nath suri are the one & same as there was a mismatch in my policy and bank account name. The same was provided by me on 21 june, 2019. After continuous follow up i was intimated by a message received from ax-nicltd that endorsement no. ………... Has been passed against your policy no...………. On 26 june, 2019.

And today i have received your letter dated 26 june, 2019.

Please note that deduction of a huge amount of rs. 20, 388/- which amount to rs 64% of bills is not acceptable to me. I, therefore, demand a recalculation of your claim settlement and pay me the lawful claim without any further delay. The bill in question is an interim bill and final bill on completion of treatment will be submitted in due course, which needs to be settled as & when submitted., please note that i am still under plaster and treatment under dr, pankaj walecha, the treating surgeon.

Please note that i am holding above policy since my retirement from bank of india as chief manager since 2015 under tie up between bank of india & national insurance company. This was my first claim under domiciliary treatment in the last 4 years. The first and only bill in four years has been grossly mishandled by your company. Please be advised above policy has since been renewed vide policy number[protected] which is valid till 26 june, 2020.

I am sure you/your office will move with all positivity in the matter. Hoping for an early revert.

Regards

Capt. S. N. Suri