Denial of Mediclaim by The Oriental Insurance Co. Ltd
FYI, my wife Ms Jyoti Srivastava got operated for Hernioplasty in Apollo Hospitals Sec 26 Noida.
Following are the details:
Admission Date: 24/07/2010 Discharge Date : 27/07/2010 Consultant : Dr. Neel Shah Cash Bill(INR): 77,071.00She is covered under The Oriental Insurance Co. Ltd. Medi Claim Policy No. 411601/48/2010/546, Member ID: O55638189ACCEL Policy Valid Till: 31-Jul-2010
As per Records the policy started in August 2008. All premiums paid upto date (i.e. Jul2010 and onwards also continued) Now the Insurance company denies to give the claim. They say the particular operation (Hernioplasty) comes under 2 years exclusion. Please see if the premium has been paid for all the 24 months ( at beginning of each month), and if operation date falls at the last week of the last month (24rth month). Shall not Insurance claim be disbursed?
Kumar Sankalp Noida, Uttar Pradesh Email: kumar.sankalp@accelfrontline.com1 Comment
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@ Kumar Sankalp
Since the operation has taken place before the expiry of the two year period from the commencement of the Policy, the claim falls within the exclusion period as per Policy Terms.
We do not know of any mediclaim policy taking monthly premiums.