[Resolved]  Star Health And Allied Insurance Company Limited — Ignoring genuine claim and Cheating on me

Address: Chennai, Tamil Nadu

Dear Sir,

I would like to introduce myself, K.T. Janakiraman, bearing Star Health Policy No. P/700001/01/2010/002278 and Claim intimation No. CLI/MIG/2010/700001/0058327. With reference to the claim rejection letter received on April 21, 2010, I would like bring the following to your notice.

I was on official duty to New Delhi in the month of February 2010. During my stay at New Delhi, I was suffering severe epigastric tenderness and recurrent vomiting. On 23rd February 2010, I met Dr.Sandeep Gulati for treatment at Kailash Hospital, Noida.

Since the diagnosis of illness was very much severe, Dr.Sandeep Gulati advised the need for proper treatment. Further, I was duly admitted to the hospital for diagnosis and medication on 23rd February, 10 (9 PM). Subsequently, post diagnosis & medication, I was duly discharged on 25th February, 10 upon medical consultation & the consulting doctors approval. I wish to bring to your notice, Star Health Insurance Representative Dr. Harish Nagpal also visited on 24th February,10 to verify my admission & the treatment administered to me apart from completing the formalities associated with claim insurance.

Upon going through the fine print of the clause regarding claim, the following is clearly stated in the policy document from Star Insurance. Also, the following is specified as exclusion in the Claim Rejection Letter:

“Could have been treated as Out Patient Basis”

I wish to reiterate, my case was very sever recurrent vomiting and epigastric tenderness and needed proper diagnosis for treatment. That is why as specialist Dr. Sandeep Gulati MD (Med) and DM (Gastro) had advised to admit for the treatment which was duly followed by me.

I have been following up on claim settlement for the past month & a half with your offices but with no result. Finally, I received a communication from your office dated 16th April, 10 stating the claim has been rejected with reason stating this case could have been treated as Out Patient in spite of the consulting doctor admitting me.

I have been made to run pillar & post and have duly submitted the following documents through your branch office in Mysore apart from speaking to your representative (Ms/Niramathi) who have advised me to write a written complaint in this regard.

I would sincerely request you to look into this case & duly do the claim settlement. I have been regularly paying my premiums apart from recommending Star to many of my colleagues. In spite of this, for a genuine case, if there is a claim rejection, I will be left with no choice but to approach consumer forum in this regard.

Look forward to hearing from you at the earliest.

Best Regards,
KT Janakiraman
MYSORE.
99863.91720