Raksha Tpa Pvt Ltd — rejection of claim number [protected]

Indu Kesar

from Pathankot, Punjab

Address:	Amritsar, Punjab, 143001
Website:	www.rakshatpa.com

As per telephonic conversation on[protected] on 11 may i was told told claim has been passed and claim amount 2 lakhs would be credited to bank account on friday.
To my utter shock today morning my claim status showed rejected as per clause 4.1 and 4.2
I want to bring to your notice that rejection on basis of clause 4.1 and 4.2 is invalid.
As per clause 4.1 any disease which is preexisting is excluded from insurance. We have repeatedly brought to your notice that mr rajesh kumar was not suffering from any ailment before suffering from heart attack. We have already submitted the required document and declaration stating that there were no preexisting ailment.
Also as per number two in reason of non payable it is stated that is k/c/o dm. We want to highlight the mr rajesh kumar is not diabetic. Neither he was suffering before heart disease nor is he suffering now.
Also clause 4.2 there is a list of diseases which are not payable if manifested during currency of policy want to highlight heart surgery is not included in this list.
We got insurance from your company considering its brand value however it is setback for me to see such level o[censored]nprofessionalism from your end. We are not at all convinced with the rejection reason that are conveyed to us. It humble request to reconsider the decision since i am writing this on facts and documents already submitted from our end.

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May 20, 2018

Updated by Indu Kesar The matter had been pending for long since 6th Nov 2017.
As per telephonic conversation on[protected] on 11 May I was told claim has been passed and claim amount 2 lakhs would be credited to bank account on 11 May 2018 (Friday).
To my utter shock on 15 May 2018 my claim status showed rejected as per clause 4.1 and 4.2
I want to bring to your notice that rejection on basis of clause 4.1 and 4.2 is invalid.
As per clause 4.1 any disease which is preexisting is excluded from insurance. We have repeatedly brought to your notice that Mr. Rajesh Kumar was not suffering from any ailment before suffering from heart attack. We have already submitted the required document and declaration stating that there were no preexisting ailment.
Also as per number two in reason of non-payable it is stated that is k/c/o DM. We want to highlight the Mr. Rajesh Kumar is not diabetic. Neither he was suffering before heart disease nor is he suffering now.
Also clause 4.2 there is a list of diseases which are not payable if manifested during currency of policy want to highlight heart surgery is not included in this list.
We got insurance from your company considering its brand value however it is setback for me to see such level o[censored]nprofessionalism from your end. We are not at all convinced with the rejection reason that are conveyed to us. It humble request to reconsider the decision since I am writing this on facts and documents already submitted from our end.
Kindly help in resolving the issue