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Mediclaim policy
Repudiation Letter No. EMSL/REJ/1100032670 dated

From: sanjay phadnis

To: [email protected]

Cc: [email protected]; [email protected]

Sent: Sat, 4 September 4:16:28 PM

Subject: National insurance claim-Your rejection of claim based on 6th April comments sent by e- meditek Indore your TPO

Dear sir,

Despite my repeated reminder and clarification, my case is not considered and reject for small reason of hypertension which was indicated in my discharge report of Bhopal Memorial Hospital Research Center, Bhopal.

In many cases like me, it is instructed by judicial and other consumer courts that company can not deny claim for hyper tension. But despite all over and above, you have lossed all my original bills and claim papers papers submitted to you with claim and no action is initiated so far. Due to which I am deprived for justice through court.

I am compel to go to court for your this conduct.

Regards,

Sanjay S. Phadnis,

My Present address:

10, Chitragupta Nagar, Kotrasultanabad, Bhopal, M.P. 462003

My Previous address:

123, Aradhana nagar, Kotrasultanabad, Bhopal, M.P. 462003

To,

The Branch Manager,

National Insurance Corporation,

Opposite Jubilee Gate,

Division Office II

B-8, Indrapuri, Bhopal- 462022

Dear Sir,

Subject: Clarification on Draft Repudiation Letter without prejudice dated Nov

10’2008

Reference No. – 1. Repudiation Letter No. EMSL/REJ/1100032670 dated

10.11.2008

2. Your reference No. NI/INDV/1000319597

3. My Mediclaim Policy No. 321300/48/07/8500000277 dated 31.3.2008

4. Your rejection of claim based on 6th April comments sent by e- meditek

Indore your TPO

Despite all facts submitted to TPO, my claim on bised ground has been rejected

resulted me loss of 3.47 lacs. However after your decision, I have resubmitted

my case to Govt. Of Madhya Pradesh and based on record, they agreed to reimburse

claim of Rs. 1, 67, 122/- as against Rs. 3, 47, 027. I requested you to reconsider

my case for review but no action was taken at your end over and above my all

original bills are held for no reason and imposing me undue loss of interest on

money I had taken on loan for my treatment.

I request you to take early action and return my all documents along with bills

for reimbursement from Govt to the tune of Rs. 1, 67, 122/-.

My previous correspondence is as given below along with my office letter dated

2818/PD/PICU/Estt 03/Medical Bills, Bhopal dated 14/9/09.

I, Sanjay Sitaram Phadnis, age 50 Years, 123, Aradhana Nagar, Kotra-sultanabad,

Bhopal-46 had purchased Medi-claim Policy from Notational Insurance Co.

Ltd, Division Office No. II, B-8, Indrapuri, Oppo. Jublee Gate, BHEL, Bhopal on

30.3.2008. My Policy was approved after my thorough Medical Checkup i.e.

Pathology Test, ECG and after measurement of BP and other required examinations

from Sharda Hospital & Diagnostic Centre, 189-A, Aaradhana Nagar,

Kotrasultanabad, Bhopal (M.P) who is authorized hospital for the said policy

investigation on 30.3.2008 being I was approx. 50 Years Age.

It has surprised me that even after complete medical checkup, only on the basis

Discharge Summary Report dated 15.09.08 of Bhopal Memorial Hospital and Research

Centre, Bhopal wherein it is mentioned that Past History HTN 5-6 years, my claim

is rejected without knowing facts of the history.

You will appreciate that I have not tried any manipulations in the Discharge

Summary report of BMHRC and despite many wrong information given in summary

report, I have submitted it for consideration. Now it is necessary to bring all

facts before you for reconsideration of my claim-

1. That in Discharge Summary under “Risk Factor” it is mentioned that

patient chewed tobacco in past. I am surprised to read it now as I never chewed

tobacco in my life time, infact a small leaf of tobacco with Pan Causes me Vomit

sensation and chakkar. I could not be held responsible for this wrong

information furnished by some of my dearer, who furnished these details under

great stress. I know that under such circumstances our dearer and nearer are

more interested in admitting patient and desire quick relief. But before

referring to one single word hyper tension for 5 years in risk factor and

Htn-5-6 Years in Past history, Discharge Summary of Sharda Hospital and

Diagnostic Centre who referred my case was completely ignored. In this report

nothing is mentioned regarding Hypertension. Therefore reason of ground for

rejection is not acceptable as at the time of admission and referred to BMHRC,

my condition was unstable though BP was 130/80 mm Hg and none of my dearer was

in position to narrate history, so my accompanied who came for hospitalization

briefed about this. (Attaching verified copy of Discharge summary for your

perusal)

2. That my medical checkup done at the time of issuing policy i.e.

30.3.2008 is completely ignored and I am not told by any Doctor that you are

having serious risk factor of hypertension and therefore not suitable for any

claim under these policies. (Attaching ECG and Blood test report for mediclaim

for your perusal)

3. That similar case of wrong discharge card issued by National Hospital,

(For Heart and critical care, Bhopal) where Dr. Shailendra Dube, M.D.Medicine

referred me for some ECG and pathological test on 15.10.08. I had Chakkar and

Ghabrahat on same day, but Doctor mentioned in his discharge card that I had

chest discomfort and chakkar. (Copy of same attached for reference).

4. That I am amazed that why my medical policy was issued knowing these

facts. Because for Medical checkup I was in the hospital from 6:30AM morning

till 10 AM when Doctor examined me. The report was directly received by your

agent and submitted to National Insurance Co. Ltd. for further processing.

5. That if ever I was told by any of the Doctor that you have this risk

factor, certainly I would have had taken due precautions and attempted for

required tests to know the condition of my health so that timely remedy is

possible. Your policy was not purchased to protect my interest. Because on

30.3. three more policies in favour of my wife. Dr. Mrs. Meenal Phadnis, my

daughter Miss Shruti Phadnis and my Son Shravan Sanjay Phadnis were purchased on

27.3.2008 and all four were purchased in true sprit with good intention. No

person would like disease like heart attack but 2 crore people are sufferer in

India and hardly 30% gets signal. You have misquoted this clause in your 10

Nov letter. It is not applicable in such cases where first time someone come

across such situation suddenly.

6. That I am incharge of Division of prestigious World Bank project in M.

P. Water Resources Department and workaholic in nature. Daily I work 12 to 14

hours and leading this life from last 10 years. I never had any complaint of

headache, problem in inhalation and any kind of pain. In fact I went to Sharda

hospital to checkup problem like acidity sensation on 8.9.2008 and first time I

had this problem in presence of Doctor. I thank to God for giving me at-least

one signal and taking advantage of close facility, I preferred to get examined

from Doctor. Let me know that BP which is even not known to me was really an

issue of non reimbursement or company had taken stand to save huge claim by

raising some or other reason

7. That if a person like me is denied for such reasons, let me speak to

you that what support will be given to rural illiterate people of this country

by Insurance companies. Therefore I strongly represent my case and request you

to consider in the light of above mentioned facts. Otherwise I will have no

option but to fight this case for justice for no fault of mine.

Case is submitted for reconsideration and justice without prejudice. And once

you decide to reject and even no ready to reimburse it for any reason what so

ever it may be, please refund same immediately so that some relief can be

availed from my Govt.

Enclosure- As above

Sincerely,

Sanjay Sitaram Phadnis,

123, Aradhana Nagar,

Kotrasultanabad, Bhopal-462003

From: ganesh Mishra

To: [email protected]

Cc: [email protected]; amit parashar ; EMSL

INDORE ; [email protected];

[email protected]

Sent: Monday, 6 April 12:07:31 PM

Subject: Re: Reminder: Clarification on Draft Repudiation Letter without

prejudice dated Nov 10'2008_Sanjay Phadnis

Sir,

With reference to your policy no.321300/48/07/8500000277& claim no.319597, claim

status Repudiation, today we are dispathching the original claim file to NIC DO

2 (Bhopal), address mentioned below. Kindly contact Mr. Vinay Shukla for your

concerned matter.

Divisional Office 2

B-8, Indrapuri Bhel

opp. Jublee Gate

BHOPAL

Regards

Dr. Archana Jena

Medical Officer

0731-4272753

For

Mr. Ganesh Mishra

Br. Incharge

EMSL-Indore

&-- Original Message &--

From: Amit Parashar

To: Emslindore ; Ganesh Mishra

Cc: [email protected]

Sent: Friday, April 03 4:14 PM

Subject: FW: Reminder: Clarification on Draft Repudiation Letter without

prejudice dated Nov 10'2008_Sanjay Phadnis

Dear Team,

Please revert.

Warm Regards,

AMIT PARASHAR|Manager - Operations (Customer Service) |E Meditek Solution

Limited

Tel :- 0124-4555091 | Mob:- 09311363436 |www.emeditek.com|

%%%%%%%%%%__

From: Prashanta Patra [mailto: [email protected]]

Sent: Friday, April 03 3:59 PM

To: [email protected]

Subject: FW: Reminder: Clarification on Draft Repudiation Letter without

prejudice dated Nov 10'2008_Sanjay Phadnis

%%%%%%%%%%__

From: sanjay phadnis [mailto: [email protected]]

Sent: Friday, April 03 3:40 PM

To: e-meditek; e-meditek; e-meditek

Cc: Chandra Shekhar Sakalley; Chandra Shekhar Sakalley

Subject: Reminder: Clarification on Draft Repudiation Letter without prejudice

dated Nov 10’2008_Sanjay Phadnis

Dear Archna,

Please recall my e-mail dated 26.1.09 wherein I requested you to return my

original Voucers of medicine and other reports for my reimbursement from Govt of

MP. I have bear enogh loss due to rejection of claim. Now handover my all

document in original keeping photocopy for your record.

My friend Mr. Sakalle will contact you at your office to receive all documents.

Please send my papers at the earliest.

With Regards,

Sanjay Phadnis

123, Saikrupa Aradhananagar,

Kotrasultanabad, Bhopal (M.P.)-462003

& On Mon, 26/1/09, sanjay phadnis wrote:

From: sanjay phadnis

Subject: Re: Reminder: Clarification on Draft Repudiation Letter without

prejudice dated Nov 10’2008_Sanjay Phadnis

To: "e-meditek", "e-meditek",

"e-meditek", "e-meditek"

Cc: "Ankur Phadnis"

Date: Monday, 26 January, 6:49 PM

Dear Archna,

Thank for your Final Repudiation Letter (Repudiation Letter No.

EMSL/REJ/1100032670 dated 10.11.2008). As my claim s rejected under

mediclaim. I request you to please send my all cash memo and medical reports

which were submitted to you for claim settlement so that I can put my matter for

medical claim from my state Govt. or else. In case you find some difficulty,

please write to me quickly.

My brother Mr. Ankur Phadnis can contact you at your office to solve your

problem.

Please send my papers at once and earliest.

With Regards,

Sanjay Phadnis

123, Saikrupa Aradhananagar,

Kotrasultanabad, Bhopal (M.P.)-462003

& On Wed, 10/12/08, sanjay phadnis wrote:

From: sanjay phadnis

Subject: Reminder: Clarification on Draft Repudiation Letter without prejudice

dated Nov 10’2008_Sanjay Phadnis

To: "e-meditek", "e-meditek",

"e-meditek", "e-meditek"

Cc: "Akhil", "Ankur Phadnis"

Date: Wednesday, 10 December, 5:02 PM

& On Tue, 25/11/08, sanjay phadnis wrote:

From: sanjay phadnis

Subject: Clarification on Draft Repudiation Letter without prejudice dated Nov

10’2008_Sanjay Phadnis

To: "e-meditek", "e-meditek",

"e-meditek", "e-meditek"

Cc: "Ankur Phadnis"

Date: Tuesday, 25 November, 5:54 PM

Dear Archana,

I hope you have recd. hard copy with original reports sent to you through Speed

Post.

Please acknowledge receipt of same.

With Regards,

Sanjay Phadnis

& On Mon, 17/11/08, sanjay phadnis wrote:

From: sanjay phadnis

Subject: Clarification on Draft Repudiation Letter without prejudice dated Nov

10’2008_Sanjay Phadnis

To: "e-meditek", "e-meditek",

"e-meditek", "e-meditek"

Cc: "Ankur Phadnis"

Date: Monday, 17 November, 8:40 AM

To,

Dr. Archana Jena,

E-meditek Solutions Limited,

Indore Bo 704, Rajani Bhavan Commericial Complex 569/1,

M. G, Road. Opposite High Court,

Indore- 452003

Subject: Clarification on Draft Repudiation Letter without prejudice dated Nov

10’2008

Reference No. – 1. Repudiation Letter No. EMSL/REJ/1100032670 dated

10.11.2008

2. Your reference No. NI/INDV/1000319597

3. My Mediclaim Policy No.

321300/48/07/8500000277 dated 31.3.2008

I, Sanjay Sitaram Phadnis, age 50 Years, 123, Aradhana Nagar, Kotra-sultanabad,

Bhopal-46 had purchased Medi-claim Policy from Notational Insurance Co.

Ltd, Division Office No. II, B-8, Indrapuri, Oppo. Jublee Gate, BHEL, Bhopal on

30.3.2008. My Policy was approved after my thorough Medical Checkup i.e.

Pathology Test, ECG and after measurement of BP and other required examinations

from Sharda Hospital & Diagnostic Centre, 189-A, Aaradhana Nagar,

Kotrasultanabad, Bhopal (M.P) who is authorized hospital for the said policy

investigation on 30.3.2008 being I was approx. 50 Years Age.

It has surprised me that even after complete medical checkup, only on the basis

Discharge Summary Report dated 15.09.08 of Bhopal Memorial Hospital and Research

Centre, Bhopal wherein it is mentioned that Past History HTN 5-6 years, my claim

is rejected without knowing facts of the history.

You will appreciate that I have not tried any manipulations in the Discharge

Summary report of BMHRC and despite many wrong information given in summary

report, I have submitted it for consideration. Now it is necessary to bring all

facts before you for reconsideration of my claim-

1. That in Discharge Summary under “Risk Factor” it is mentioned that

patient chewed tobacco in past. I am surprised to read it now as I never chewed

tobacco in my life time, infact a small leaf of tobacco with Pan Causes me Vomit

sensation and chakkar. I could not be held responsible for this wrong

information furnished by some of my dearer, who furnished these details under

great stress. I know that under such circumstances our dearer and nearer are

more interested in admitting patient and desire quick relief. But before

referring to one single word hyper tension for 5 years in risk factor and

Htn-5-6 Years in Past history, Discharge Summary of Sharda Hospital and

Diagnostic Centre who referred my case was completely ignored. In this report

nothing is mentioned regarding Hypertension. Therefore reason of ground for

rejection is not acceptable as at the time of admission and referred to BMHRC,

my condition was unstable though BP was 130/80 mm Hg and none of my dearer was

in position to narrate history, so my accompanied who came for hospitalization

briefed about this. (Attaching verified copy of Discharge summary for your

perusal)

2. That my medical checkup done at the time of issuing policy i.e.

30.3.2008 is completely ignored and I am not told by any Doctor that you are

having serious risk factor of hypertension and therefore not suitable for any

claim under these policies. (Attaching ECG and Blood test report for mediclaim

for your perusal)

3. That similar case of wrong discharge card issued by National Hospital,

(For Heart and critical care, Bhopal) where Dr. Shailendra Dube, M.D.Medicine

referred me for some ECG and pathological test on 15.10.08. I had Chakkar and

Ghabrahat on same day, but Doctor mentioned in his discharge card that I had

chest discomfort and chakkar. (Copy of same attached for reference).

4. That I am amazed that why my medical policy was issued knowing these

facts. Because for Medical checkup I was in the hospital from 6:30AM morning

till 10 AM when Doctor examined me. The report was directly received by your

agent and submitted to National Insurance Co. Ltd. for further processing.

5. That if ever I was told by any of the Doctor that you have this risk

factor, certainly I would have had taken due precautions and attempted for

required tests to know the condition of my health so that timely remedy is

possible. Your policy was not purchased to protect my interest. Because on

30.3. three more policies in favour of my wife. Dr. Mrs. Meenal Phadnis, my

daughter Miss Shruti Phadnis and my Son Shravan Sanjay Phadnis were purchased on

27.3.2008 and all four were purchased in true sprit with good intention. No

person would like disease like heart attack but 2 crore people are sufferer in

India and hardly 30% gets signal. You have misquoted this clause in your 10

Nov letter. It is not applicable in such cases where first time someone come

across such situation suddenly.

6. That I am incharge of Division of prestigious World Bank project in M.

P. Water Resources Department and workaholic in nature. Daily I work 12 to 14

hours and leading this life from last 10 years. I never had any complaint of

headache, problem in inhalation and any kind of pain. In fact I went to Sharda

hospital to checkup problem like acidity sensation on 8.9.2008 and first time I

had this problem in presence of Doctor. I thank to God for giving me atleast one

signal and taking advantage of close facility, I preferred to get examined from

Doctor.

7. That if a person like me is denied for such reasons, let me speak to

you that what support will be given to rural illiterate people of this country

by Insurance companies. Therefore I strongly represent my case and request you

to consider in the light of above mentioned facts. Otherwise I will have no

option but to fight this case for justice for no fault of mine.

Case is submitted for reconsideration and justice without pre-judice.

Enclosure- As above

Sincerely,

Sanjay Sitaram Phadnis,

123, Aradhana Nagar,

Kotrasultanabad, Bhopal-462003

Copy of e-mail

Clarification of Draft Repudiation Letter without prejudice dated Nov 10’2008

Sunday, 16 November 1:01 PM

From:

"sanjay phadnis"

View contact details

To:

[email protected], [email protected], [email protected],

[email protected]

Cc:

"Shravan Phadnis"

Message contains attachments

Sharda Hospital_Discharge Summary.pdf (841KB), National Hospital_Discharge

Card.pdf (687KB)

To,

Dr. Archana Jena,

E-meditek Solutions Limited,

Indore Bo 704, Rajani Bhavan Commericial Complex 569/1,

M. G, Road. Opposite High Court,

Indore- 452003

Subject: Draft Repudiation Letter without prejudice dated Nov 10’2008

Reference No. – 1. Repudiation Letter No. EMSL/REJ/1100032670 dated

10.11.2008

2. Your reference No. NI/INDV/1000319597

3. My Mediclaim Policy No.

321300/48/07/8500000277 dated 31.3.2008

I, Sanjay Sitaram Phadnis, age 50 Years, 123, Aradhana Nagar, Kotra-sultanabad,

Bhopal-46 had purchased Medi-claim Policy from Notational Insurance Co.

Ltd, Division Office No. II, B-8, Indrapuri, Oppo. Jublee Gate, BHEL, Bhopal on

30.3.2008. My Policy was approved after my thorough Medical Checkup i.e.

Pathology Test, ECG and after measurement of BP and other required examinations

from Sharda Hospital & Diagnostic Centre, 189-A, Aaradhana Nagar,

Kotrasultanabad, Bhopal (M.P) who is authorized hospital for the said policy

investigation on 30.3.2008 being I was approx. 50 Years Age.

It has surprised me that even after complete medical checkup, only on the basis

Discharge Summary Report dated 15.09.08 of Bhopal Memorial Hospital and Research

Centre, Bhopal wherein it is mentioned that Past History HTN 5-6 years, my claim

is rejected without knowing facts of the history.

You will appreciate that I have not tried any manipulations in the Discharge

Summary report of BMHRC and despite many wrong information given in summary

report, I have submitted it for consideration. Now it necessary to bring all

facts before you for reconsideration of my claim-

1. That in Discharge Summary under “Risk Factor” it is mentioned that

patient chewed tobacco in past. I am surprised to read it now as I never chewed

tobacco in my life time, infact a small leaf of tobacco with Pan Causes me Vomit

sensation and chakkar. I could not be held responsible for this wrong

information furnished by some of my dearer, who furnished these details under

great stress. I know that under such circumstances our dearer and nearer are

more interested in admitting patient and desire quick relief. But before

referring to one single word hyper tension for 5 years in risk factor and

Htn-5-6 Years in Past history, Discharge Summary of Sharda Hospital and

Diagnostic Centre who referred my case was completely ignored. In this report

nothing is mentioned regarding Hypertension. Therefore reason of ground for

rejection is not acceptable as at the time of admission and referred to BMHRC,

my condition was unstable though BP was 130/80 mm Hg and none of my dearer was

in position to narrate history, so my accompanied who came for hospitalization

briefed about this. (Attaching verified copy of Discharge summary for your

perusal)

2. That my medical checkup done at the time of issuing policy i.e.

30.3.2008 is completely ignored and I am not told by any Doctor that you are

having serious risk factor of hypertension and therefore not suitable for any

claim under these policies.

3. That similar case of wrong discharge card issued by National Hospital,

(For Heart and critical care, Bhopal) where Dr. Shailendra Dube, M.D.Medicine

referred me for some ECG and pathological test on 15.11.08. I had Chakkar and

Ghabrahat on same day, but Doctor mentioned in his discharge card that I had

chest discomfort and chakkar. (Copy of same attached for reference).

4. That I am amazed that why my medical policy was issued knowing these

facts. Because for Medical checkup I was in the hospital from 6:30AM morning

till 10 AM when Doctor examined me. The report was directly received by your

agent and submitted to National Insurance Co. Ltd. for further processing.

5. That if ever I was told by any of the Doctor that you have this risk

factor, certainly I would have had taken due precautions and attempted for

required tests to know the condition of my health so that timely remedy is

possible. Your policy was not purchased to protect my interest. Because on

30.3. three more policies in favour of my wife. Dr. Mrs. Meenal Phadnis, my

daughter Miss Shruti Phadnis and my Son Shravan Sanjay Phadnis were purchased

and all four were purchased in true sprit with good intention. No person would

like disease like heart attack but 2 crore people are sufferer in India and

hardly 30% gets signal. You have misquoted this clause 4.1 in your 10 Nov

letter. It is not applicable in such cases where first time someone come across

such situation suddenly. You will appriciate that I have not hide any fact till

now.

6. That I am incharge of Division of prestigious World Bank project in M.

P. Water Resources Department and workaholic in nature. Daily I work 12 to 14

hours and leading this life from last 10 years. I never had any complaint of

headache, problem in inhalation and any kind of pain. In fact I went to Sharda

hospital to checkup problem like acidity sensation on 8.9.2008 and first time I

had this problem in presence of Doctor. I thank to God for giving me atleast one

signal and taking advantage of close facility, I preferred to get examined from

Doctor.

7. That if a person like me is denied for such reasons, let me speak to

you that what support will be given to rural illiterate people of this country

by Insurance companies. Therefore I strongly represent my case and request you

to consider in the light of above mentioned facts. Otherwise I will have no

option but to fight this case for justice for no fault of mine.

Case is submitted for reconsideration and justice without pre-judice.

Enclosure- As above

Sincerely,

Sanjay Sitaram Phadnis,

123, Aradhana Nagar,

Kotrasultanabad, Bhopal-462003


Company: Mediclaim policy

Country: India   State: Madhya Pradesh   City: Bhopal

Category: Business & Finance

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