We have submitted (02) no of claims on behalf of my father in Aug -14 . The details of the claim is mentioned below.. – Claim number – HH251500135 – Rs. 10303.00 – Claim number – HH251500145 – Rs. 14140.00 Co. Name : The New India Assurance Co. Ltd , Bhubaneswar DO II,B-34,Sahidnagar, Bhubaneswar- 751007 ,Orissa TPA Name : Heritage Health TPA “Nicco House”, 5th Floor, 2, Hare Street,Kolkata -700001 After several follow up with the insurance co & TPA , finally both the claims are rejected on 16/01/2015 mentioning pre-existing clause . I requested to provide the documentary evidence that clearly shows that the specific cause/disease due to which hospitalization took place from the registered medical practitioner (mentioning his registration number) who has reviewed the case file for both the claim no HH251500135 and HH251500145 , but nothing has been provided. I have also sent a published news regarding judgment of Madras HC on rejection of medi claim on the ground of pre-existing disease, published in Business Standard dt. 09-02-2014 . In the 2nd & 3rd paragraph the report clearly shows that “ The doctors alone could identify them….” And “…come to influence that one disease is relatable to other disease and, therefore mediclaim is rejected…” . They did not agreed to understand my point that ‘A patient might have any pre-existing illness which can cause hospitalization but not necessarily all hospitalization can happen due to pre-existing disease..’ I have also registered compains to IRDA in this regard and the grievance application No is: 01-15-013963 Hence request your kind support in this regard.

We have not been provided documentary evidence from Medical Partitioner neither from the TPA nor the Insurance Co. Thus the co-relation between the hospitalization with the pre-existing disease not confirmed . We want the proof or else the claim reimbursement with additional consequence charges at the earliest.

Email Id: tathagata275@gmail