Rajendra Prasad
New member
- Policy Name
- 71948339
- Company Name
- Care Health Insurance
- Customer Care Number
- 18001024488
- Loss Amount
- 207167
- Ratings
- Opposite Party Address
- Vipul Tech Square, Tower C, 3rd Floor, Golf Course Road, Sector-43, Gurugram-122009, Haryana
Dear Sir/Madam,
I would like to bring to your notice that my self Rajendra Prasad, underwent knee replacement surgery at Shalby Multi-Specialty Hospital, Ahmedabad, Gujarat.
Policy No.: 71948339
Claim No.: 96608456
I have submitted a claim for medical expenses amounting to ₹3,07,167, but only ₹1,00,000 has been approved and paid.
When I contacted your customer care team to understand the reason for the reduced settlement, I was informed that there is a capping of ₹1,00,000 for knee replacement surgery.
However, I would like to point out that there is no mention of such a capping in the policy bond that I received via email. Moreover, at the time of purchasing the policy, no information was provided regarding any such limit on knee replacement claims.
I also informed your customer care representative that this capping is not mentioned in the policy document. If such a restriction exists, kindly provide the relevant clause and page number of the policy terms and conditions where it is clearly stated.
In view of the above, I request you to kindly review my claim and process the balance amount as per the policy coverage, or provide a detailed written explanation along with the supporting policy clause for limiting the claim to ₹1,00,000.
I look forward to your prompt response and an early resolution of this matter.
Thank you.
Yours faithfully,
Rajendra Prasad
Mobile no-9852879599
I would like to bring to your notice that my self Rajendra Prasad, underwent knee replacement surgery at Shalby Multi-Specialty Hospital, Ahmedabad, Gujarat.
Policy No.: 71948339
Claim No.: 96608456
I have submitted a claim for medical expenses amounting to ₹3,07,167, but only ₹1,00,000 has been approved and paid.
When I contacted your customer care team to understand the reason for the reduced settlement, I was informed that there is a capping of ₹1,00,000 for knee replacement surgery.
However, I would like to point out that there is no mention of such a capping in the policy bond that I received via email. Moreover, at the time of purchasing the policy, no information was provided regarding any such limit on knee replacement claims.
I also informed your customer care representative that this capping is not mentioned in the policy document. If such a restriction exists, kindly provide the relevant clause and page number of the policy terms and conditions where it is clearly stated.
In view of the above, I request you to kindly review my claim and process the balance amount as per the policy coverage, or provide a detailed written explanation along with the supporting policy clause for limiting the claim to ₹1,00,000.
I look forward to your prompt response and an early resolution of this matter.
Thank you.
Yours faithfully,
Rajendra Prasad
Mobile no-9852879599