| Address: Mumbai City, Maharashtra |
Dear Sir,
I SHEOKUMAR VENKTESHWARNATH PANDEY have taken a insurance policy named "Family Health Optima" from Star Health and Allied Insurance company Limited, vide their Policy No.:- P/171115/01/2013/010505, dated 06/10/2012 For the period of Insurance from 06/10/2012, 13:13:34 To Midnight Of 05/10/2013, against basic floater sum insured for Rs. 3,00,000/- and made payment of Rs.13,348/- vide cheque No.511142 dated 29/09/2012 of HDFC Bank Koparkhairane Branch and received receipt No.[protected] dated 06/10/2012, for the same with no pre existing diseases.
I would like to bring your kind attention that on dated 17/10/2012 I was admitted to FAUZIYA HOSPITAL for diagnosis of chest pain and vomiting and given me a primary treatment and then after was shifted to LILAVATI HOSPITAL on 18/10/2012 at 02:53 AM where I was operated for ACS/STEMI/PTCA on 19/10/2012. Since Hospitals were not on Depanneled list of Star Health and Allied Insurance Co.Ltd; I made all payments of hospitals and medicines expenses etc. And after paying all bills was discharged on 23/10/2012.
I have given the Intimation to the Star Health and Allied Insurance Co. Vide Intimation No.:- CLI/2013/171115/0112228, on dated 18/10/2012 and also submitted all the related documents, bills etc. Along with fully filled Claim forms to their Vile Parle Mumbai Office on dated 10/11/2012 for the reimbursement. After many reminders on online they register my Claim on 24/11/2012 and whenever I check my claim Status showing UNDERPROCESS for many days, on 07/12/2012 while checking online, my claim status was showing nothing, then after immediately I made a Toll free call to their Chennai office and was assured that my claim file is with their medical teams and I will be reimbursed very soon. On very next day ie. On 08/12/2012 I was very surprised to see on online that my Claims are rejected showing.
Remarks :- We have perused the claim records relating to the above insured-patient sent to us seeking reimbursement of hospitalization expenses for the treatment of ACS/STEMI/PTCA. The insured-patient was admitted in the hospital on 18.10.2012 and as per the medical certificate of the treating doctor and the discharge summary of the above hospital, the insured patient has symptoms of the above disease from 17.10.2012 which falls during the first 30 days from the date of commencement of the policy . As per Exclusion 2 of the above policy, the company is not liable to pay any claim pertaining to treatment of diseases contracted during the first 30 days from the date of commencement of the policy. We therefore regret our inability to admit your claim for the insured person under the above policy and we hereby repudiate your claim.
When company is taking premium for 12 Months and the person insured is cover for 12 months then why the first 30 days from the date of commencement of the policy is not covered. That means company is taking premium for 12 Months and covering insurance for 11 Months WHY!
Kindly Help Me, since I am already in debts.
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