Claim Repudiation of policy no. 190100/11001/1000295842

Location/place: Ahmedabad

Name of company/service: Apollo Munich Health Insurance Co. Ltd.

Dear Sir/Madam

Sub: Claim Repudiation of policy no. 190100/11001/1000295842, claim no. 96197 from Apollo Munich Health Insurance Co. Ltd.
With reference to above subject, I undersigned Samir B. Vasavada has taken Mediclaim policy from Apollo Munich Health Insurance Co. Ltd. our policy no. is 190100/11001/1000295842.

Prior this I have mediclaim policy since last 7-8 years with National Insurance Co. Ltd. I have not taken any claim of mine from National Insurance Co. Ltd. So pre existing stands nullify.

Under the portability guide lines, I have switched the company and moved to Apollo Munich Health insurance co. Ltd. And if you read the policy conditioned, it is clearly mentioned that” Mr Samir B Vasavada For Rs 250000 (Rupees Two Lakh Fifty Thousand) Sum Insured – Sec 6B), Sec 6C) and Sec 6D) of the policy wording is waived.”

I had put claim file for reimbursement for Left Eye Retinal Detachment in Nov-12.of Rs. 32374/- I have received the letter/email from the Apollo Munich Health Insurance Co.Ltd. that my claim has been rejected due to “1) As the present condition is a sequalae of High Myopia which is pre existing prior to policy inception, the claim cannot be reopened and reprocessed as per Section 6) D) of the policy.Also hospitalization of 24 hrs not warranted nor a listed Day care procedure. Hence cannot be reopened and reprocessed.

I had been hospitalized for 24 hrs. So it was NOT a day care procedure. Original Discharge summary along with bill submitted for processing of claim.

My policy has been continued since long and my policy itself says that Sum Insured – Sec 6B), Sec 6C) and Sec 6D) of the policy wording is waived.”. So pre existing clause does not apply to me.I shall get my claim amount.

Requested to give us natural justice.

Thanking you
Yours truly,

Samir B Vasavada