Office Of The insurance
Ombubsman,
23, N.S.Road, 2nd floor, KOLKATTA 700001,
West Bengal.
Appeal for Balance Amount Payment
Claim No. 1805340
Policy No. 154100/48/10/8500000285
Insured Name: SANTI KUMAR ROY
Dear sir,
Thank you for settlement of my Husband claim of Rs.80, 000/- (incl. Cashless). From your claim settlement letter I understood that you settle the claim on the basis of Total Sum Insured Rs.1 lac against Varistha Mediclaim Policy issued by the National Insurance Company, Burdwan Branch.
MYSELF Mrs. Maya Roy, aged 59.years is covered under Individual Mediclaim Policy issued by your Burdwan Branch of your Company along with my late husband, Mr. S. Roy (Proposer) and other family members continuously since 2007 There was no claim till 2010.
In the year 28/05 my late husband Mr Santi Kumar Roy preferred to shift from Individual Mediclaim Policy to Varishtha Mediclaim Policy with Rs.1, 00, 000/- for Normal medical disease and 2, 00, 000/- for critical illness. (copy enclosed).
In the year 2010 on 17th September my husband fell sick and he was admitted at AMRI Hospital, Salt Lake for treatment of Heart Attack and expired on 5th Oct A sum of Rs. 30, 000/- was sanctioned as Cashless benefit by the TPA and though the actual expenses was near about Rs. 6 lacs. I lodged the claims with all the relevant documents for re-imbursement on 29/10.
On 08/03 I have received Rs. 80, 000/- (incl. Cashless) from the TPA, Medi-Assist copy enclosed. But as per Varishtha Mediclaim Policy issued by National Insurance Company, policy covers Rs.1 Lac for Normal Medical treatment and Rs.2 Lacs for Critical Illness Treatment. My Husband Late Shanti Roy died in Critical illness which is covered under your policy condition.
Now I appeal to you for reconsideration of my appeal and request you to settle the balance amount of claim as early as possible.
Kindly take a necessary action immediately
Thanking You
Yours truly,
MAYA ROY
37, SOUTH KALNA ROAD
, BURDWAN, 713101
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