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21%
1.35 

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Rejection of Claims without Valid reasons
Mar 29, 2010 12:59 PM 14180 Views

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I bought Royal Sundaram's Secure Plus policy based on recommendation from my Relationship Manager of Standard Chartered Bank - in November 2009.Important features that I liked were -


(1) Free vouchers for Medical Checkup every 2 years


(2) Renewable up to 75 Years


(3) Pocket allowance during hospitalization in the month of January, my wife started suffering from a gynecological problem and we had to go in for investigation (Soonography).


After the report, we were advised to carry out a surgical procedure (DNC).This required 1 day of hospitalization. We submitted all the documents to Paramount (Royal Sundaram's front end processing agency). We also fulfilled all the requirements of additional documentation, Duplicate documentation etc. and to make number of trips to Paramount's office as all requirements were not told in one go.Once we received a telephonic confirmation (after more than 1 month) that everything is in order and and advisory panel will review it, we got a mail stating that the claim is rejected because - “ Dr. Prescriptions indicate Past History of Heavy Menstrual Flow ”.


There is no mention as to which prescriptions they are referring to. No analysis, logic mentioned as to how they came to this conclusion. Only additional information in mail is copy - pasted clauses that give information on exclusions of ailments with past history. I protested though e-mail and gave them 1 week to provide be detailed logic of rejection. Even after 10 days, there is no information this.


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