12-20-0063881-01

Reimbursement Claim ID 6122385073522 is rejected

Mrs Saroj
C/O DHARMVIR WARD NO 8 MAHAM,ROHTAK HARYANA,NEAR BUS STAND
NA
NA
Mehem
HARYANA
124112

Date: 26-12-2023

Dear Mrs Saroj,

As your trusted insurance advisor, it is our endeavour to support you and partner with you for better health. However, we regret to inform you
that we are unable to approve your Claim ID 6122385073522 for your Aditya Birla Health Insurance- Activ Secure Plan 2 plan with Policy Number
12-20-0063881-01 received on 27-06-2023 03:28:29 via NA.
On scrutiny of the documents it was observed that it is noted that the claim is intimated for accidental death .However we have noted for
discrepancy and misrepresentation in the documents and nature of death . and hence we are unable to approve your Claim.

Intimation details received from you are as following:

Patient details
1 Member ID 000563483111
2 Policy Holder’s Name / Corporate Name / Master Policy holder Name Mrs Saroj
3 Policy Number / COI Number 12-20-0063881-01
4 Claim Registration Number 6122385073522
5 Patient Name Mrs Saroj

Treatment details
1 Hospital Name ABHI hospital for OPD claims
2 PolicyHospital Address ABHI MBC office,ABHI MBC office,,Thane,400615
3 Ailment Death due to electric Shock
4 Date of Admission 22/05/2023 03:30 PM
5 Date of Discharge 22/05/2023 03:30 PM
6 Claim Amount Rs.3300000.00
Please read the policy document with reference to the above and refer to the clause mentioned below:
Policy Clause Number Policy Clause Description
N. Duty of Disclosure
The Policy shall be null and void and no Benefit shall be payable hereunder in the
event of an untrue or incorrect statement, misrepresentation,
mis-description or non-disclosure of any material particular in the Proposal Form,
personal statements, declarations, medical history and
connected documents, or any material information having been withheld by the
Policyholder or any one acting on their behalf, under this Policy.
Under such circumstances We may at Our sole discretion cancel the Policy and the
premium paid shall be forfeited to Us.
NA
O. Fraudulent Claims
If any claim is found to be fraudulent, or if any false declaration is made, or if any
fraudulent devices are used by You or the Insured Person or
anyone acting on their behalf to obtain any Benefit under this Policy, then this
Policy shall be void and all claims being processed shall be forfeited
for all Insured Persons. All sums paid under this Policy shall be repaid to Us by You
on behalf of all Insured Persons who shall be jointly liable for
such repayment.
In case of a grievance, you can contact us with the details through:

WhatsApp Send ‘Claim’ to 8828800035 from your registered mobile number

Raise a Request Click here to raise a request
Helpline Number Call us at 18002707000
Email ID Write to us at care.healthinsurance@adityabirlacapital.com

You can also walk-in and approach the grievance cell at any of our branches (click here to find our nearest branch). If in case you are not satisfied
with the response then you can contact our Head of Customer Service at carehead.healthinsurance@adityabirlacapital.com. If you are still
unsatisfied with our response, you may approach the nearest insurance Ombudsman. The contact details of the ombudsman offices are provided
on our website.

Regards,

Dr Abhijeet Ghosh
Authorised Signatory
Aditya Birla Health Insurance Co. Limited