Universal Sompo — Mediclaim rejected based on useless excuses.

Hello,

PN: 2825/60990652/02/000
Claim: 333916
Claim amount: Rs. 40, 000/-
Claim approval delayed by 2 months

Universal Sompo company is find baseless/useless excuses when you claim your insurance after 3 years.

I have clarified their query but they don't want to listen.

They rejected my mediclaim based on the below reasons.

1. On further scrutiny of claim documents, it was observed that hospital forged entire cash receipt on the name of insured but as per insured payment detail entire hospital payment was by digital payment.

2. Pathology forged the payment receipt with same amount for same receipt number at different date for insured.

3. Moreover, it was also observed that signature of qualified pathologist was forging by pathology center as per need of health insurance policy.

Please find my answer/clarification below.

1. How do you know that I paid the entire bill digitally? (I had never mentioned it anywhere.) Seems your team has misunderstood. I paid 10, 000/- via Google pay/ Digital. rest all hospitals paid by cash only. [I have also mentioned that in my statement. your investigator has taken a photo of the 10k transaction from my mobile]

Let me clarify it.
₹ 5000 Cash was Deposited on 09/01/2023.
₹ 10000 Google Pay + ₹1350 Cash rupees notes = ₹11350 Paid on 13/01/2023.
₹ 16350 Total paid to the Hospital.

For your information, it doesn't matter if I pay via cash rupees, cheque, net banking, digital or credit card. I paid my full hospital bill mix-way digital and cash rupees.

I have also discussed with hospital management about the same. They said we provide the receipt against the payment. It doesn't matter if it's cash rupees or digital or any other mode.

[protected]

2. If a third party/pathologist or their staff / their accountant or their cashier does a typo mistake or human mistake then what should I do? This is a baseless/useless reason for rejection.

For your information. Your team has sent the biggest mistake on the "CLAIM REPUDIATION LETTER". They mention me as 2 times "SHE" instead of "HE". and 1 time "FEMALE". See attached document / your letter pdf file. This is very disrespectful.

Even your website and your mobile app don't work (I have already raised my complaint about the same.). Even if your company isn't working perfectly then how can you reject a claim based on a single mistake.?

[protected]

3. Pathologist's Sign: This is again a useless/baseless reason.

I have discussed this with the pathologist for the same. They said who told you the sign isn't right of a qualified pathologist? all the signed by qualified pathologists.

Thank you
Bhavinkumar