Star Health And Allied Insurance — grievance against rejection of your claim

Address: Thane, Maharashtra, 421201

To,
The grievance department.
Star health and allied insurance company ltd.
1, new tank street, valluvarkottam high road,
Nungambakkam, chennai – 600034

Sub.: grievance against rejection of our claim no. Cli/2018/900000/0170934 dated 10th july 2017 for my policy no. P/900000/01/2017/000007

Respected sir / madam,

With reference to your rejection letter the copy of which is attached for your reference. I would like to state that:-

1) my wife was admitted for bleeding from uterus and d & c was done in january 2017 in hospital (Shree siddhi women`s hospital).

2) the claim for above ailment was unconditionally sanctioned by then insurance provider icici lombard.

3) since then she was under treatment & guidance of the same doctor and nursing home (Shree siddhi women`s hospital).

4) she again started bleeding per # and was administered injection by same doctor on 6th july 2017 which controlled her bleeding. But again on 9th july she started severe uncontrolled bleeding and we had to rush her to the hospital on 9th july where she was admitted in emergency and operated on 10th july as an emergency case.

5) sir/madam, you have rejected the claim and as per your rejection letter it was on the grounds that “dysuterine bleeding is neither a medical emergency nor an accidental injury.”

6) here i would like to state that any uncontrolled severe bleeding from any organ is a medical emergency and not as claimed by your side.

7) i am attaching the certificate of treating surgeon certifying that it was a medical emergency and it was necessary to operate her in emergency to control her bleeding.

8) hence i am submitting my grievance against your reasoning of claim and request you to refer any medical book or medical expert to confirm whether uncontrolled bleeding is an medical emergency or not.

9) i would also like to know the name and qualification of the concerned person /doctor who has rejected the claim on the grounds that uncontrolled severe bleeding is not a medical emergency.

10) if my grievance is not addressed in proper justification & my mediclaim is not sanctioned i will be compelled to approach insurance omdusman for justice regarding my above case

Thank you,

Hiten b. Nandu)