Pragati Gupta
V/S
National Insurance Co. Ltd.
The complainant stated that her husband was admitted in the Synergy Hospital Agra for the period from 16.03.2016 to 19.03.2016 for treatment of Acute Pancreatitis. She had incurred an expenditure of approximately Rs. 40,000/- and all the required documents, medical papers and reply to various queries raised by the TPA were submitted to the insurer but her claim had not been settled till date. On going through the documents submitted by the complainant, it is observed that the TPA had raised certain queries vide their letters dated 25.07.2016 and 02.08.2016 which were replied by the insured vide his letter dated 26.08.2016.
However, the insured informed vide letter dated 07.10.2016 that on receipt of complaint through this forum, the claim was reviewed and the insurer had agreed to settle the claim for Rs. 22,358/- subject to submission of consent of the complainant. Subsequently, the complainant, vide another mail dated 07.10.2017 has confirmed receipt of claim amount. The complaint, thus, stands closed and disposed off.
