New India Assurance — denial of claim 16497931 under 130500/34/17/04/00000051

Address:

Kurnool, Andhra Pradesh, 518222

My father was diagnosed with si of glaucoma. So we took him for check & care at naryana netharayla bangalore for treatment. Now we have submit
As per documents submitted, mr. S d nijagunappa 75/m presented with c/o hypertmetropia b/l with presbyopia with astigmatism underwent investigations and took treatment on opd basis. Treatment taken on opd basis is not payable. As per policy terms and conditions, clause 1.0 : now this policy witnesses that subject to the terms, conditions, exclusions and definitions contained herein or endorsed or otherwise expressed hereon, the company undertakes that if during the period stated in the schedule or during the continuance of this policy by renewal, any insured person shall contract any disease or suffer from any illness (Hereinafter called disease) or sustain any bodily injury through accident (Hereinafter called injury) and if such disease or injury shall require any such insured person, upon the advice of a duly qualified physician/ medical specialist/ medical surgeon (Hereinafter called surgeon) to incur hospitalisation expenses (Herein defined) for medical/ surgical treatment at nursing home/hospital in india as herein defined (Hereinafter called hospital/nursing home/ day care centre) as an in-patient the company will pay through t. P. A. To the hospital / nursing home / day care centre or reimburse the insured person amount of such expenses as would fall under different heads mentioned below in respect thereof by or on behalf of such insured person but not exceeding in any one period of insurance the amount stated hereunder. Clause 4.4.11 diagnostic, x-ray or laboratory examination not consistent with or incidental to the diagnosis of positive existence and treatment of any ailment, sickness or injury, for which confinement is required at a hospital/nursing home. Hence this claim stands denied under the policy.