Sub: CCNo. MDI 4362379
Insurance Company Claim No. TP 005120700189005135
=============================================================
The Assistt Secretary(O.S),
Life Ins Corp of India,
Central Office, 21-09-2018
Mumbai.
Dear Sir,
I had sent you the claim papers for the reimbursement of Rs 5000/- spent by me on CT Scan of the eyes of my wife as suggested by Eye Specialist Dr Aditi Agarwal, because her vision was falling, as the first step for correct diagnosis. These claim papers were sent by you to MDI where these were recd on 06-09-2018 and registered as per the details mentioned above.
Yesterday MDI has sent me a mail that the claim has been recommended for repudiation because this does not fall in the category of diagnosis tests without hospitalization and the matter may be taken up with the Insurance Company and its local office. This mail is being forwarded to you simultaneously for your perusal.
If the Policy is referred to it will be observed that C.T. Scan to the extent of Rs 5000/- is covered and the Policy does not restrict it to any part of the body. A doctor may need CT scan for eyes also to arrive at the correct diagnosis.
In this case Dr Aditi Agarwal has advised OCT- Optical Coherence Tomography, because in the case of eyes a C T scan is known by the said name in medical terms. Further, there is no exclusion of this item from the terms and conditions of the Policy. Therefore, I am of the opinion that this claim should have been settled. I have already sent the prescription, bill and CT scan report with the claim papers.
Hence I would request you to please take up the matter with New India Insurance Company to direct MDI to recommend the claim for settlement and payment should be made to me at an early date.
Meanwhile please acknowledge receipt.
Thanks,
S.R.Agarwal
Retd Secy(HPF),
L.I.C., C.O.
Mumbai
S.R.No 207257
Mob 08527571711
No comments:
Post a Comment