(ON LETTERHEAD)

LEGAL NOTICE

Date 00.00.2025

To,

M/s XYZ Co Ltd.

From:

ABC,

Advocates & Solicitors

SUB:- Deficiency in services to my client …………. by wrongful denial of cashless claim and further rejection of reimbursement of medical expenses on grounds beyond the insurance contract.

Sir. Ma’am,

Under the instructions of my client, ….., I hereby serve upon you this legal notice on account of deficiency in services to my client, by wrongful denial of cashless claim and further rejection of reimbursement of medical expenses on grounds beyond the insurance contract and/ or wrongful interpretation thereof.

1. That my client holds a mediclaim policy issued by you the noticee and is insured with your company continuously, since 01.01.2015. The same was duly got renewed by paying a premium of ₹ xxxxxx, being Policy No. 0000-000000-0000-2025.
2.  That vide the said Policy, my client was assurec  coverage of meducal expenses upto ₹10,00,000/- and is valid till 31.12.2025. The said policy included cashless services at Panel Hospitals.
3.  That on 00.00.2025 my client got hospitalized in …………. Hospital, New Delhi and her cashless mediclaim card was produced at the time of her admission, but cashless request was denied from TPA for the reasons best known to you.
4.  That on 00.00.2025 my client got discharged from the hospital and a total bill of ₹ 00,00,000/- was paid by her due to denial of cashless facility.
5.  That my client applied for reimbursement of expenses after duly filling the claim form but the same was repudiated vide letter dated 00.00.2025
6.  That the reasons stipulated in the repudiation letter is ……..
7.  That the reason is untenable as………….
8.  That furthermore, my client is continually covered under your policy since 2015.
9.  That my client has suffered a lot of inconvenience and mental agony due to this unprofessional, negligent and lackadaisical approach towards claim resolution.
10.  That in view of this deficiency in service, my client demands ₹ 1,00,000/- as damages along with the total amount of bill i.e. ₹ 00,00,000/- with interest @ 18% per annum from the date of payment at hospital i.e 00.00.2025 till disbursal. 
11.  That my client further claims ₹.10,000/- towards the expenses of sending this notice. 
12.  That a reply to this notice is expected within 15 days from the date of receipt of this legal notice failing which I have instructions from my client to initiate legal proceedings against you in the appropriate court of law at your risk.

A copy of this legal notice is retained in my office for record and further necessary action.

(Advocate)