[Resolved]  Star Health & Allied Insurance — Insurer asking irrelevant documents

We have processed the claim records relating to the above insured-patient seeking reimbursement of hospitalization expenses for the treatment of T2 DM, nephropathy, neuropathy. Although the present treatment is for neohropathy/ neuropathy apart from DM it is observed from the discharge card of Dept. of Cardiology, S. C. B. Medical College, Cuttack for the earlier admission of the insured-patient from 15.12.2009 to19.12.2009 that she has been diagnosed of CAD/ ACS/ ANT wall STEMI/ type II DM and hypertension which is prior to inception of medical policy taken with us from 08.02.2010. At the time of inception of the first policy which is from 08.02.2010 to 07.02.2011, you have not disclosed the above mentioned medical history/ health details except DM of the insured-person in the proposal form which amounts to misrepresentation/ non-disclosure of material facts. As per Condition No. 7 of the policy issued to you, if there is any misrepresentation/ non-disclosure of material facts whether by the insured person or any other person acting on his behalf, the Company is not liable to make any payment in respect of any claim. We therefore regret our inability to admit your claim under the above policy and we hereby repudiate your claim. As per condition No. 12, the policy is also liable to be cancelled. Yours faithfully, Authorized Signatory A

Above statuses from Star Health Portal, I came to know...

Hello Sir/Madam,

I have already taken claim reimbursement in[protected], so that my premium is increased. This status is totally illegal and Star health fishing me for submitting irrelevant documents to process this claim. Today they have rejected after 2 months completed submission of Claim reimbursement with required documents.

Why star health has alleged that we have not disclosed the above mentioned medical history. Star health had taken medical treatment of my mother & father and medical report collected by you. We know nothing.

We are from Rural Area (At/Po-Kapasi, Via/Ps-Niali, Dist-Cuttack-754004) from cuttack to 65kM.

after that star health issued Policy on dtd 08.02.2010-07.02.2011.

I have already taken claim reimbursement behalf of my mother from star health.

I am not hurry for reimbursement for my expenses, these expenses are my own attainable. For my one months salary i could make treatment of my mother at least one year in privileged facility with hospital.

You have to pay all the claim reimbursement with interest and respect, this is my final commitment to you.

Star health grievance department is totally mal-administrative.

If IRDA pressures to star health or not, I will get my claimed reimbursement without fail.

IRDA previous respond is like a postman to star health.

I hope this tie IRDA will take immediate action for my claim.

Background:

Medical treatment period 25th Dec, 2013 to 5th Jan, 2014 and claim reimursement documents were submitted on 9th Jan, 2014.

On 27th Jan, 2014 star health hads been raised 3nos. queries.
1. As per discharge summary patient is a know case of CAD-IWMI.kindly provide the previous treatment details, ECG, ECHO, when was CAD diagnosed? First consultation report.
2. Letter from treating doctor regarding duration of RA, CAD- IWMI.previous treatment details of RA.
3. Copy of indoor case papers. - Mandatory First,

Collected necessary documents from Medical and submitted on 31st Jan, 2014.

again star health asking for the same documents which they collected already.

and today's status and reply mentioned in above for your further action.

Thanks & Regards,
Bijaya Kumar Mohanty
+91-[protected]
+[protected]/292

We have processed the claim records relating to the above insured-patient seeking reimbursement of hospitalization expenses for the treatment of T2 DM, nephropathy, neuropathy. Although the present treatment is for neohropathy/ neuropathy apart from DM it is observed from the discharge card of Dept. of Cardiology, S. C. B. Medical College, Cuttack for the earlier admission of the insured-patient from 15.12.2009 to19.12.2009 that she has been diagnosed of CAD/ ACS/ ANT wall STEMI/ type II DM and hypertension which is prior to inception of medical policy taken with us from 08.02.2010. At the time of inception of the first policy which is from 08.02.2010 to 07.02.2011, you have not disclosed the above mentioned medical history/ health details except DM of the insured-person in the proposal form which amounts to misrepresentation/ non-disclosure of material facts. As per Condition No. 7 of the policy issued to you, if there is any misrepresentation/ non-disclosure of material facts whether by the insured person or any other person acting on his behalf, the Company is not liable to make any payment in respect of any claim. We therefore regret our inability to admit your claim under the above policy and we hereby repudiate your claim. As per condition No. 12, the policy is also liable to be cancelled. Yours faithfully, Authorized Signatory A

Above statuses from Star Health Portal, I came to know...

Hello Sir/Madam,

I have already taken claim reimbursement in[protected], so that my premium is increased. This status is totally illegal and Star health fishing me for submitting irrelevant documents to process this claim. Today they have rejected after 2 months completed submission of Claim reimbursement with required documents.

Why star health has alleged that we have not disclosed the above mentioned medical history. Star health had taken medical treatment of my mother & father and medical report collected by you. We know nothing.

We are from Rural Area (At/Po-Kapasi, Via/Ps-Niali, Dist-Cuttack-754004) from cuttack to 65kM.

after that star health issued Policy on dtd 08.02.2010-07.02.2011.

I have already taken claim reimbursement behalf of my mother from star health.

I am not hurry for reimbursement for my expenses, these expenses are my own attainable. For my one months salary i could make treatment of my mother at least one year in privileged facility with hospital.

You have to pay all the claim reimbursement with interest and respect, this is my final commitment to you.

Star health grievance department is totally mal-administrative.

If IRDA pressures to star health or not, I will get my claimed reimbursement without fail.

IRDA previous respond is like a postman to star health.

I hope this tie IRDA will take immediate action for my claim.

Background:

Medical treatment period 25th Dec, 2013 to 5th Jan, 2014 and claim reimursement documents were submitted on 9th Jan, 2014.

On 27th Jan, 2014 star health hads been raised 3nos. queries.
1. As per discharge summary patient is a know case of CAD-IWMI.kindly provide the previous treatment details, ECG, ECHO, when was CAD diagnosed? First consultation report.
2. Letter from treating doctor regarding duration of RA, CAD- IWMI.previous treatment details of RA.
3. Copy of indoor case papers. - Mandatory First,

Collected necessary documents from Medical and submitted on 31st Jan, 2014.

again star health asking for the same documents which they collected already.

and today's status and reply mentioned in above for your further action.

Thanks & Regards,
Bijaya Kumar Mohanty
+91-[protected]
+[protected]/292

U can register your complaint in consumer court

I have registered with plan from Akosha (fraud service).

No result from Star health till yet.