Hello;
I Mr.Amit Acharya cheated by health insurance ROYAL SUNDARAM GENERAL INSURANCE COMPANY BY not sanctioning my claim the reason which the insurance company giving is not in valid terms .My wife Mrs.Laxmi Acharya had laparoscopic repair of previous scar defect with excision of scar ectopic in JK WOMEN HOSPITAL LOCATED AT DOMBIVLI EAST.
We had a baby in 2018 later my wife was having whole month bleeding and whenever we went to any nearby clinic in pandemic was informed by doctors it is because hormonal chances .
but we can’t understand what was going on, my wife was taking medicine to stop bleeding and for 3 to 4 months it gets again started and later in Aug 2021 she was bleeding heavily with clots with pain we finally went to jk women hospital and met Dr.S.Krishnakumar he immediately informed us to do MRI and he informed us about my wife health condition if we will wont operate then we cannot save her and the uterus also will be removed if required he informed us
So we agreed to do Laparoscopic Surgery and hospital bill total amount was 1, 25, 000.00rs we send all original documents to royal sundaram general insurance by courier later they rejected saying on below terms:-
On detailed scrutiny of the documents submitted, we observe that:
We acknowledge receipt of the claim documents lodged under subject policy.
The claim documents have been perused by our claims panel and we observe that the insured was admitted for Caesarean Scar with Retained Products of Conception at previous scar site with scar defect. Our policy excludes any treatment arising from or traceable to pregnancy/childbirth and hence this claim is being repudiated.
Please find below the relevant policy condition for your ready reference.
e. Permanent Exclusions
xxv. Reproductive medicine.
c. Any expense incurred on treatment arising from or traceable to pregnancy (including voluntary termination of
Pregnancy, childbirth, miscarriage, abortion or complications of any of these, including caesarean section
Hence we regret our inability to consider your claim on the above grounds
So this is injustice with us they did all the investigation later they are saying it’s related to pregnancy which is not done. My wife had a surgery which was not a pregnancy how comes they can say it’s a pregnancy related surgery .The discharge summary clearly has mentioned that it was RPOCS AT PREVIOUS SCAR DEFECT then how comes royal sundaram can relate it to pregnancy.
I am attaching all the related documents please do needful we are poor people cannot afford such big amount in this Covid pandemic this is a very huge amount we paid for this laparoscopic surgery also I am regularly paying my health insurance EMI on since last 4 years if we have to pay the hospital bills from our side, then why we need such policies.
Please help us by sanctioning our insurance amount ASAP as we have took this amount in interest from others.
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