Oriental Insurance Company — Insufficiant claim pass on mediclaim policy

Address:

Rajkot, Gujarat, 360 002

My claim no. 142200/48/2017/000271 p no-142200/48/2016/17212,
My mediclaim policy sum assured for rs.1, 00, 000/-
After complain i received answer after 40 days. I have all serial mail to prove.
They are approved my claim as previous policy.

My claim for rs.51, 369/-/-
Company approved claim for rs.42, 542/-

Detail :
Operation dtd.21.05.2016

Claim submited dtd. : 07.06.2016

Approval voucher for rs.42, 542/- received on dtd.20.07.2016

I m not accept this voucher and return on dtd.21.07.2016

And after so many reminder i received replay by rajkot do1 mr. A. J. Trivedi. (No any changes in voucher)

As per my knowledge my current policy assured for rs.1, 00, 000/-

And company applied condition as previous year polcy i. E. Rs.50, 000/-

If my policy is assured for rs.1, 00, 000/- so i m alegiable hospital room rent rs.1000/- per day. So no any deduction in my hospital bill.

If company consider hospital room rent as previous policy i. E. Rs.500/- per day.

So company can pass my all bills.

I m submitting detail of my all bill here what i claimed.

1. Hospital bill rs.31, 900/-
2. Medical bill rs.13, 948/-
3. Anaesthesiology bill rs.4, 500/-
4. Krishna medical nursing home bill rs.500/-
5. R. B. Kothari laboratory bill rs.520/-
Total amount rs.51, 369/-

Please find herewith the answer i received after 41 days from rajkot do1 officer mr. A. J. Trivedi as here under.

A j trivedi
Aug 30

To me, c
Dear sir,

In reply to your letter dtd. 21st july, 2016 seeking full payment of rs.51, 367/-, we give here below details/break up of claim admissible amount rs. 42, 542/- :

* disease claim falls under exclusion for two years, hence sum insured of yr 14-15 of rs.50, 000/- is considered for admissible claim amount, but since claim lodged under current policy no-142200/48/2016/17212, terms and conditions will apply for this policy and as per this policy, room/nursing and hospitalisation charges excluding medicine charges are payable proportionate to sum insured payable on 50, 000/- (I. E. Sum insured of year 14-15)
* accordingly, break up of claim amount comes as under :

Total payable amount during hospitalisation is rs.28, 000/-

650 : 500 } 36400 = 36400 x 500/650 = rs.28, 000/-

(1) 28, 000/- eligible payable amount
(2) 520/- r b kothari 16/5/16
(3) 500/- krishna hospital 17/5/16
(4) 13, 500/- medicine 6 bills
(5) rs.42, 542/- total claim payable

We hope now matter is clear to you and we request you to kindly accept the voucher and return to us duly signed along with bank details to enable us to make payment.

Thanking you,

With warm regards,

A j trivedi,
Divisional manager d o 1,
Rajkot
Phone no[protected]
Cin-u66010dl1947goi007158
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You are requested please guide me how much more time i need to wait for my full payment of my claim rs.51, 369/-

Should i go for any court matter for my claim?

Thank you
Bharat chokshi
[protected]

Please do needful.