Star Health And Allied Insurance — grievance: cheating by star health agent

Address: Gurgaon, Haryana, 122001

Website: www.starhealth.in

Sir,
I purchased a star health policy p/161128/01/2017/000863 on 17/01/2017 for my father mr. Lila ram through your agent mr. Umesh grover (Intermediary code ba[protected]).

My father was suffering from coronary artery disease (Cad) and underwent an angioplasty with stent on 30 nov 2016. When we took the policy, we gave all heath records to the agent and told him clearly about the pre-existing disease and asked him to mention the same in proposer form.

He went to the village, collected all the documents and got the proposer form signed from my father.

After some days, he told us that the policy was issued. But, he didn't send the policy documents to us, neither we receive the documents through email or post. When checked, he told us not to worry and told that the policy has been issued and is proper. He told as per the policy, the pre-existing disease will be covered in the next year i. E. 2018.

This year, the renewal was due and it got renewed on 29/01/2018 with number p/161128/01/2018/001320. We paid the renewal premium of rs. 42, 480.

Unfortunately, my father got some issue with health and he was admitted to hospital on 07th feb 2018. Doctors prescribed him the angioplasty with 2 stents. When i checked with tpa desk, they tried to get a pre-approval for the claim and a claim no. 0582636 was registered with star health.

To our surprise, the claim got rejected and the reason was "pre-existing disease" was not mentioned in the first policy by the agent.

I checked with the agent and he told that he attached all documents and mentioned it in the form. But, star claim team was saying it is not mentioned.

So, my claim was rejected and i had to pay rs. 2.5 lakhs to the hospital.

This is a clear case of cheating by star health agent and their team. They are running a racket in which first they make false promises to the customers and then at the time of requirement, they reject the claims.

What was my fault in this? I didn't receive the first policy document by email or post in 15 days, so couldn't see the pre-existing mentioned. If i would have seen it, i would have cancelled the policy or get it updated in time.

I will also file this complaint in irds and will also file a suit in the consumer forum so that in future they don't cheat the customers in the name of health insurance.