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Claim Rejection by RakshTPA, Oriental Insurance




Dear Sir,

I'm having a Oriental Insurance mediclaim policy family floater # 12400/48/2010/29650, under which I made a claim for Rs. 36000/- for my right eye cataract surgery on 5th Jan '11 afternoon, at Hiranandani Hospital, Mumbai. The Raksha TPA was intimated by Fax, email and courier on 7th Jan well within 48 timeline for intimation and all the original docs were submitted to them on 10th Jan.

The Raksha TPA website shows that my claim has been rejeted for the following reason. Besides this I ve not received anything in writing from them.

"We are in receipt of your claim documents. As per available documents, patient was admitted for Rt.eye cataract. Patient was been admitted on 05/01/2011 and discharged on 05/01/2011.As per policy terms & condition claim should be intimated to TPA within 48 hours from date of hospitalization. Hence this claim stands non payable under Exclusion Clause 5.4"

The website also mentions that "24-JAN-2011 BLUE BIRD MAIL SERVICES PVT.LTD(Nonpayable Letter)" which is not received by me so far.

I ve made a complain to Oriental Insurance on the same dated 27th Jan as per their website status, and so far not received any comm. from them too.

Please advise what should I do next. Thanks Regards, Manoj agrawal,

(Posting of mail ids & mob. no. is against Forum Rules -hence deleted)


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This portal is only dedicated to discussing issues related to the RTI Act 2005.


You will not get any answers here to general doubts and requests for help in non RTI related matters.


In any case, it is too early to pursue the matter through RTI.

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