After blast in J&K, victim hit by insurance bombshell

As if losing her mother and suffering severe injuries in a mysterious blast in Kashmir wasnrsquot traumatic enough for Neeta Jethwa the 54yearold was forced to wait around at a private hospital in Mumbai till Saturday evening even after being discharged in the morning as the third party administrator TPA for her medical insurance company had not cleared her bills Insult to injury Neeta Jethwa has mediclaim coverage of Rs 4 lakh but her cashless claim was initially denied by the third party insurance administrator PicAnita Anand The Ghatkopar resident was hurt in the explosion on a Tempo Traveller in Anantnag on July 28 that killed four Mumbai women mdash one of them succumbed to her injuries on August 1 mdash and wounded seven others According to Ketan Mehta a relative Neeta was admitted to a private hospital in Ghatkopar W after being airlifted from Kashmir She and her husband Bharat have mediclaim coverage of Rs 4 lakh each and hence it was decided to get the entire treatment cashless Dr Mukund Jagannathan plastic and reconstructive surgeon who operated on Neeta said ldquoWhatever could be done has been done We have to wait and watch how she recovers post surgery She will require rehabilitative physiotherapy laterrdquo However Mehta and the Jethwas were shocked on August 3 when Ms MD India Healthcare Services Pvt Ltd informed them that they were lsquounable to issue authorisation letter for cashless access for the said patientrsquo citing New India Assurancersquos exclusion clause 441 mdash war and warlike perils are not covered under the policy ldquoWe were aghast with the bizarre reasoning for the denial There was no war nor any war like peril that led to the blast Moreover JampK police is yet to ascertain the exact cause of the explosion How did the TPA conclude that there was a war or warlike peril in JampK This is absolutely absurdrdquo Mehta said Piling on the pain According to Mehta the TPA even failed to provide a satisfactory reply It was only after Mehta threatened to lodge a complaint with Insurance Regulatory and Development Authority IRDA that MD India responded saying they would study her case again Mehta added ldquoNeeta had already lost her mother Nirmalaben Rathod 78 in the explosion and was also injured herself The entire family was undergoing tremendous stress and the TPA insurance representatives only added to our painrdquo The Jethwas and Mehta said they are thankful to AD Sarnik divisional manager of New India Assurance NIA who intervened and spoke to the TPA after which they agreed to clear the claim However Mehta said by Saturday evening the hospital had prepared a final bill for Rs 76163 but the insurance company only cleared Rs 70723 ldquoWe have decided to file a formal complaint with IRDA and NIA against the TPArdquo the family said Expertspeak Dr SK Kamath member of Consumer Guidance Society of India said ldquoThe aggrieved party can approach the Ombudsman of Insurance and can even write a complaint directly to IRDA The reasoning for rejection of claim by the TPA is absurdrdquo The other side When contacted Dr Naimuddin Karbari senior manager operations for Ms MD India Healthcare Services Pvt Ltd who rejected the claim via an email copy with this paper said ldquoI am not in office and Irsquove learnt the claim has been approved nowrdquo When asked how they concluded there was lsquowar and warlike perilrsquo in JampK due to which they rejected the claim Dr Karbari said ldquoI cannot comment on this I have to study the case indepthrdquo Chaitanya Gujarathi assistant general manager from Ms MD India Healthcare Services Pvt Ltd said ldquoI am out of Mumbai and cannot make any statementrdquo Meanwhile a senior officer from New India Assurance admitted there was indeed a mistake on part of the TPA in rejecting the claim without discussing the same with the concerned divisional officer of NIA The officer even clarified that clause 441 is not appropriate for the case and that he would discuss the matter with the TPA and would carry out a detailed probe Sushmita Mukherjee chief regional manager Mumbai Regional Officendash2 New India Assurance said ldquoI cannot comment without going through the papers but we promise to look into the matterrdquou00a0