Dear Sir,

I had put up a claim on above policy for my son Archit Bhargava on 22nd May, 2010.

He was diagnosed "Bilateral Dry Eyes and Corneal defect error in both eyes. He could not use lenses due to very high refractory powers. His eye sight number had gone up to 8.25 and 7.50 respectively.

He was advised by more than one Ophthalmologist to undergo Laser Keratomileusis surgery to save his eyes. The procedure was necessary due to very high refractory powers.

This surgery was done on 19th of May, 2010 by Dr Anand Shroff at his Eye center at Bandra.

All the necessary papers along with the claim form had been submitted to Health India TPA.

We had not received any official communication either from Oriental Insurance or Health India. However, on inquiring with Health India, we were told on phone that our claim is rejected citing reason that the surgery was done for cosmetic reasons.

We are quite surprised and baffled at the conclusion drawn by TPA. How could they ignore the findings of not one but 2 major Ophthalmologists that such a high power of 8.25 and 7.5 makes it necessary to go for surgery to save the eyes. Its not a simple case of 1.5 or 2.5 power where people go for this surgery from cosmetic point of view. How could TPA club our case where the question of saving eyes becomes predominant due to such high powers?

We have even submitted our complaints to customer support of Oriental Insurance a month back along with 2 reminders to them but till date there is no news from their end. They have only acknowledged by giving complaint ref no. as csd/bro-11/103/2010 but no further news on our claims till date.

We hereby request you to intervene on our behalf and get due justice to our valid case and the claim. We expect Oriental to release our claim as 100% passable. We have seen many cases where the same surgery done on lower power such as 5.5 plus or so, 100% claims are given by Insurance companies.

We hope to hear from you soon on our case.

Thanking you in advance,

Yours Truly,
Anoop Bhargava
Father of Archit Bhargava