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Health Insurance Claim, My Brother bought the Health insurance from ROYAL SUNDARAM on 22nd Feb 2018

Complain ID : CCN031693   29  

Insurance Complaint Complaint Date: May 6, 2018
Modified date: May 15, 2018
My Brother bought the Health insurance from ROYAL SUNDARAM on 22nd Feb 2018 and Unfortunately, My Nephew diagnosed with Typhoid and doctor advised us to admit him in Hospital for better treatment and we did (27th Feb). As we have Health Insurance Policy, We went for cashless facility. Now after three day during discharge, TPA sent the letter of claim to Insurance company and THEY REJECTED the Claim and said Child diagnosed a fever which is very close to waiting period of 30 days. Hence Cashless can not be accorded and go for reimbursement but we fought so much and they said Sorry we will check why this was happend with you. they asked for documents we sent them through Courier after 15 days they rejected my reimbursement claim as well and said "We acknowledge receipt of the claim documents lodged under subject policy. On perusal of the claim documents, we observe that the admission is for SEPSIS. Treatment taken could have been done on outpatient basis and does not warrant hospitalization.
Hence, we regret our inability to consider your claim on the above grounds."

They are doing cheating with us. Please help i have all the doctors reports and my policy and i am eligible for claim.
Complaint Against / To: Royal Sundaram general insurance

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