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Manishkumar Prajapati on 13 July 2012
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The oriental insurance disagreement of claim settlement no.126061200124

Dear sir, we have to inform you that our tpa e-meditek, has considered your claim for rs.45000/- (Sum insured rs. 00/- Less co payment 10% as per terms and conditions of the policy). You have insured your family, as under. Year type of policy sum insured 2007 individual mediclaim rs.25000/- 2008 individual mediclaim rs.50,000/- 2009 individual mediclaim rs.50,000/- 2010 individual mediclaim rs.50,000/- Rs.--100000 0011 happy family floater rs.3,00,000/- 2011-2012--claim year happy family floater rs.3,00,000/- As per annaxture a-form, dully filled in by the authority of lilavati & research centre, mumbai, where the treatment was taken, it is clearly mentioned that the duration of present disease suffered, since – 007. More over it is further mentioned that deformity & shorting of rt. Arm since-2007.As per policy terms and conditions your claim has been fall under exclusion clause no 4.1, which can be read as under.Pre-existing health condition or disease or ailment/Injuries : any ailment/Disease/Injuries/Health condition which are pre-existing (treated/Untreated, declared/Not declared in the proposal form), in case of any of the insured person of the family, when the cover incepts for the first time, are excluded for such insured person up to 4 years of this policy being in force continuously.Hence, tpa has considered you claim under above mentioned exclusion no 4.1, and considered the available sum insured in the year 008, I.E. Rs. 00/- And settled the claim accordingly. Hope, now the matter is clear to you. However, please feel free to contact us if any further grievance. With thanks and regards, mukesh joshi branch incharge bo umergaon , dear sir, as per your valuable suggestion. I give clarity my daughter had bone cyst in right hand was found after biopsy was taken on 8/09 at baroda. (Om orthopedic). On that doctor asked me how long you feel this cyst in hand. We asked to him before one year. On that time when biopsy was taken a cyst is very small & no painful for my daughter. Doctor suggested to me we can’t do anything in this disease only wait & watch. We took X-ray every six month for examinations. Doctor doesn’t want to disturbed this cyst. We also refer to surat & ahmedabad but get same feedback. Doctor not agrees for operations that why we wait for progress for natural filling. If we have idea for operation in future we increased amount of our policy (in 007) why we wait for 6 year. Before 3 month of operations my daughter suffers high pain in hand during 10th exam. We consult doctor & he suggested to operate cyst due to this may be fracture in bone. We have no alternate on that time. We decided to operate this cyst. If it is not pain/Increase size of cyst why we should do operations. This type of cyst in bone may be present in every person for long life nobody bothers about if not give pain. This is not a pre-existing deases. May be I have cyst in bone ?.But no idea unitll I suffer pain. Please you consider this claim is fresher and give me full settlement. Regards zankhana prajapati 6729 4171