Health Policy Claim

Wed, 16 May 2018 - INSURANCE - Uttar Pradesh
Ashok Singh person
Uttar Pradesh State
INSURANCE Industry
Royal Sundaram General Insurance Company
Unsatisfactory Services dispute
Compensation claim
Complaint Details

<p class="MsoNormal"><span style="font-family: arial, helvetica, sans-serif;">Through this portal, I would like to inform you and literally not happy the Royal Sundaram Insurance Policy so the case was like that My Brother bought the Health insurance from ROYAL SUNDARAM on 22nd Feb 2018 and Unfortunately, My Nephew diagnosed with Typhoid and doctor advised us to admit him in Hospital on same day (27th March 2018) for better treatment and we did. As we have Health Insurance Policy, We went for cashless facility. Now after three day during discharge, TPA sent the letter of claim to the company and THEY REJECTED the Claim and gave the illogical reason that&nbsp;Child diagnosed a fever which is very close to waiting period of 30 days. Hence Cashless can not be accorded and go for reimbursement but we fought so much and they said Sorry we will check why this was happened with you. they asked for documents we sent them through Courier after 15 days they rejected my reimbursement claim as well and said "We acknowledge receipt of the claim documents lodged under subject policy. On perusal of the claim documents, we observe that the admission is for SEPSIS. Treatment taken could have been done on outpatient basis and does not warrant hospitalization. Hence, we regret our inability to consider your claim on the above grounds." I again asked them to call me and they called me said doctor did not advise you to admit your child in hospital. I told that how can anyone admit his child in hospital without doctor&rsquo;s advise, they said we will check again with our claim team and I sent them all the document over the email again with proofs in which doctor stated to admit your child in hospital asap and the report also justified the critical condition of our child.</span></p>rn<p class="MsoNormal">&nbsp;</p>rn<p class="MsoNormal">&nbsp;</p>rn<p class="MsoNormal"><span style="font-family: arial, helvetica, sans-serif;">They are doing cheating with us. Please help us , we have all the doctors reports and policy and are eligible for claim otherwise there is no benefits of buying these policies.</span></p>rn<p class="MsoNormal"><span style="font-family: arial, helvetica, sans-serif;">THEY TOLD ME YOUR CHILD WAS NOT CRITICAL TO ADMIT IN HOSPITAL.</span></p>rn<p class="MsoNormal"><span style="font-family: arial, helvetica, sans-serif;">please advise me and ban such types of company.</span></p>rn<p class="MsoNormal"><span style="font-family: arial, helvetica, sans-serif;"><span style="mso-bidi-font-size: 11.0pt; mso-ascii-font-family: Calibri; mso-hansi-font-family: Calibri; mso-bidi-font-family: Calibri;">&nbsp;</span></span></p>

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