Star Health And Allied Insurance — Rejection of claim

Hello,

I am very disappointed at the way Star Insurance handled my mothers case. They never did any tests when they issued the policy, though I insisted for them to conduct the same. My mom underwent a Gall Bladder stone removal operation in June 2012, before they carry on the operation, all tests were conducted & heart valves were clear. Over a period of time, she had chest pain & showed to the doctor in Novemeber & she underwent a surgery On Dec 6th, 2012. They concluded that it is a pre-existing disease. We had declared that she was under no medication for heart nor she had any issues when this policy was initiated. How did they determine that it was "Pre Existing"?

We wrote a letter & they just denied even speaking to us. They said the team visited the hsopital, but met none (Neither me nor my mom). There was no valid grounds, as to how it was denied.

Inclined below are the details & a mail that came after months:


Name of the insured-Patient : Mrs.N.VIMALA
Product name : Senior Citizens Red Carpet Insurance
Policy number : P/141126/01/2013/000497
Policy period : From:14-MAY-2012 To:13-MAY-2013
Claim Intimation number : CLI/2013/141126/0139676
Diagnosis : ischemic heart disease and triple vessel disease.
Date of admission : 05/12/2012
Name of hospital & location : Fortis Hospital -Cunning Ham Road, BANGALORE
We have perused the claim records relating to the above insured-patient sent to us seeking reimbursement of hospitalization expenses for the treatment of ischemic heart disease, and triple vessel disease.

Our medical team has observed that the CAG report shows multiple critical HTN, diffuse total occulusive coronary artery disease involving all coronaries with collateral and distension, which denotes it is a chronic long standing disease present prior to inception of medical insurance policy. The present ailment of the insured patient is therefore a pre-existing disease.

As per Exclusion No.1 of the policy issued to you, the Company is not liable to make any payment during the first year of operation of policy, in respect of expenses for the treatment of pre-existing diseases, for which treatment or advice was recommended or received during the immediately preceding 12 months from the date of policy.

We therefore regret our inability to admit your claim under the above policy and we hereby repudiate your claim.

Incidentally, it is brought to your attention that the above pre existing disease is not disclosed by you at the time of inception of the policy. It is now incorporated in your policy by passing an endorsement by our operating office.


Yours faithfully,


Authorized Signatory
If you have any grievance against the above decision, you may represent to :

GRIEVANCE DEPARTMENT
STARHEALTH AND ALLIED INSURANCE CO.LTD.
No. 1, New Tank Road, Valluvarkottam High Road, Nungambakkam, Chennai-34., PH:28288800


I still have been continuing to pay the insurance. But they do not respect the clients.