Syed Ahmed Ali Shah
V/S
Oriental Insurance Co. Ltd.
The complainant had taken Mediclaim Policy for the period from 27.11.2015 to 26.11.2016 from The Oriental Insurance Co. Ltd. He was hospitalized in Max Super Speciality Hospital, Ghaziabad on 26.08.2016 with acute ischemic stroke and discharged from the hospital on 29.08.2016. The complainant had applied for a cashless facility but the same was rejected by the company.
Thereafter, the claim was lodged by the complainant with all the relevant documents for reimbursement but the same was too not settled by the company in spite of various reminders. The company stated that the claim was settled by them on 25.09.2017 after deducting the amount of Rs.20,595/- due to non-availability of MRI films and ECHO reports. The insurer informed that they had confirmed from the hospital that an MRI was done and accordingly they were settling the claim. That an amount of Rs.20,595/- was approved by the company for settlement of the claim was later also confirmed by the complainant vide his email dated 08.11.2017.
