[Resolved]  Star Health And Allied Insurance — Claims Medical Rejection - CLI/2015/181113/0103144

Address:

Kottayam, Kerala

My name is Pratheesh and I am writing on behalf of my Father, Mr. KJ Thomas. I have Star Health's mediclaim called "senior citizens red carpet health insurance" for my Father since 3 years continuously. Three (3) months back, he had Knee replacement surgery. Before the date for surgery, we contacted the agent working in our branch who sold this insurance to us and he assured my dad's eligibility based on completing 2 years and also confirmed cashless facility at this hospital. At the time of admission, hospital admin informed that Rs.50, 000/- was approved by Insurance company and balance will be paid as required but after surgery, we were informed that our claim was not approved. When enquired, company said the claim is rejected for "Suppression of Material Facts" and sent us a letter to confirm. I took this particular insurance called "senior citizens red carpet health insurance" for my dad based on what was explained by their branch office at kottayam, Kerala and it is also mentioned in their website that, "All pre existing diseases are covered from 1st year except those for which treatment was received during immediately preceding 12 months. Disease for which treatment was recommended or received during preceding 12 months from date of purchase will be covered from 2nd year onwards". So even if he had disclosed the disease at the time of buying this policy, he is still eligible for benefits since his Policy is in effect for more than 3 years. The surgery costs around 3 lakhs and we had to arrange cash immediately which put us in a very bad situation. Please advise. Thank you.