MD India Health Care Services
Rejection of Claim

Rusi K. Shroff

749, Mithoo Villa, 1st Floor, Parsi Colony, Road No.6, Dadar, Mumbai 400 014

Telephone No: 24134944

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Sub: Rejection Of Claim Amount Of Rs.21787/-

I had lodged a Claim of Rs.21787/- on 06.08.2010 under Mediclaim Polcy No.130700/34/10/11/00003350. On 27.08. I received your Claims Rejection / Repudiation Statement dated 25.08.2010 in which you have Rejected the said Claim Under Clause 4.4.11. In connection with the same I have to state as under:

It is mentioned in the Claims Rejection Statement that present illness Acute Episode Of Imbalance Labrynath Disturbance is since %% as per Policy Terms and conditions.

In reply to the same I state that I fail to understand why the period of illness has been left blank by MD India? I, further state that it is incorrect and false to state that the illness mentioned above was pre-existing. However, I confirm that the said illness was triggered due to a bad fall I had at my residence in the early morning of 21.07.2010. The intensity of the fall resulted in bleeding from the head and caused giddiness and imbalance, due to which I had to be admitted to the ICU of the Parsee General Hospital.

It is also mentioned that no active line of treatment was given during Hospitalisation and hence Claim is not payable Under Clause 4.4.11.

In reply to the same I state that it is also incorrect and false to mention that no active line of treatment was given during Hospitalisation. On the contrary, upon being admitted to the Casualty Department of the B.D. Petit Parsee General Hospital, the head wound was stitched and dressed up, after which I was admitted to ICU under observation. Since Dr. Jimmy A Lalkaka, Neurologist attending to me wanted to rule out the possibility of multiple head injuries and blood clots, advised M.R.I of the head and E.C.G, both of which were done on 21.07. Reports of which are already submitted to MD India on 06.08.2010. Since both the Reports turned out to be normal, except general medication, there seemed no requirement for any other scope of treatment.

It may kindly be noted that it is a common practice among Doctor’s to first ascertain the actual degree / intensity of injury caused to a patient and for that, they rely upon X-Rays, M.R.I or CT Scan Reports, only after which the actual line of treatment commences and I am sure that the panel of MD Doctors shall agree with me on the same. Hence, it is improper and unjust on the part of MD India to conclude that no active line of treatment was given during Hospitalisation and to reject the Claim Under Clause 4.4.11.

In the light of the above mentioned genuine and convincing explanations offered by me, I feel betrayed and cheated by MD India and strongly protest against MD India for rejecting my rightful Claim Under Clause 4.4.11 which is not at all applicable to me. I would like to place on record that the rejection quoted Under Clause 4.4.11 is an insult to the Doctor’s fraternity, especially Dr. Jimmy A Lalkaka, Neurologist, who in his professional opinion got me admitted to the ICU of the B D Petit Parsee General Hospital.

I, once again reiterate the fact that the head injury resulting in loss of blood and causing giddiness and imbalance, certainly required attention and due Hospitalisation, without which my health could have worsened or further deteriorated and hence, I sincerely appeal to MD India to stop this harassment tactic and to kindly reconsider its decision and approve the Claim amount of Rs.21787/- which I truly deserve.

Yours truly,

Rusi K Shroff

Company: MD India Health Care Services
Country: India
State: Maharashtra

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