STAR HEALTH CO - CLAIM REJECTED

To,

consumer forum court
jamshedpur jahrkhand


i like to lodge a case against star health insurance co because they reject my claim with wrong reason also bimalokpal given worst decision in favor of star health insurance co.


complete case details:-

my name is nikhat bano i have a star health comprehensive policy of sum ***,*** rs .i went to tata main hospital for treatment for ovarian cyst dr.vinita singh suggest for cyst removal operation so i submit the all the documents to insurance desk at tata main hospital bistupur jamshedpur.******.jharkhand ** apr **** for approval. my claim intimation number is. *******.but same day i get a call from star health insurance and they said my claim is rejected and they given a reason which is not mention in policy documents.(i attached ).they said its related to ovarian disease and its cover after two years of policy cover. i know i read the policy documents i know if any kind of ovarian related disease its cover after * years but i am going to treat by cyst and cyst is happened any place of body in liver, throat, kidney any part in body so it is not a particular diseases with ovarian and cysts itself a disease not its come under ovarian disease so how can you decline my claim kindly explain me very clear did not see in policy documents you wrote cyst related diseases cover after two years.(star health insurance has to mention in policy documents very clear about cyst related diseases but its not available in policy documents i attached here for reference)

so now i want to open a case through ombudsman scheme with clause no. d
( misrepresentation of policy term and condition at any time in the policy document or policy contract)

as they said ovarian disease means cyst i have attached * health insurance providing companies policy exclusion and documents here for your reference i have a simple question if cyst is not a particular disease and not necessary to mention in policy documents why these * health insurance company mention about cyst very clear in policy documents.

*.hdfc ergo *.cignatkk *.reliance *.icici lombard *.relegera insurance .

i attached here hard copy of treatment documents, supportive documents, my bills of my case and my policy documents.

due to rejection of my claim with baseless reason i send so many emails to star health insurance company but they reply me the same thing they are trying prove me wrong because they don’t want to pay my money ***** rs which i pay in hospital for my operation of cyst .
i already file the complaint in igms online portal and my complaint number is. gr********** but they closed my complaint without any investigation so i again reopen my case gr********** irda token no.**-**-****** at ** may **** but still i did not get any solution for my case igms just close the case without taking any action and without complaint satisfaction so what is the benefit of complaint through igms kindly clarify me igms just help the insurance company to cheat poor people which question i rise in my complaint i did not get reply from star health insurance company even igms close my case .
so i kindly requested to you please take necessary action against star health insurance and refund my amount as earlier is possible. i face mentally and physically torched by them due to wrongly rejection of my claim.

after that i go to bima lokpal patna my complain no is. (pat-h-***-****-****)** may **** and after * months they send me letter for hearing of my case at ** aug **** but that time i was in bangalore because my son major heart surgery is going on. so that’s reason i did not reach the hearing in patna .later at ** sep **** they send me letter for award of my case bima lokpal given very bad decision in favor of star health insurance co even i provide him all the evidence which proof my claim is genuine and correct .after his decision i write so many emails i ask bimalokpal to provide me official law or leeter from irda which proof that your decision is correct but they never reply me. if you want i can provide you all the emails details.

i ask so many times star health insurance co rejection reason but i never get answered from them because they given false reason to reject my claim they don’t have answer of my truth questions.

q*.why i go for treatment.
ans. because my cyst is in abnormal size grow in ovaray so i go for treatment its not mean my ovary is abnormal .no report show i have any diseas in my ovaray.doctor suggest me for operation because my cyst size is abnormal no ovary it’s very clear.
q*.what operation report said?
ans.in both report one after operation and * after test of raw material which take out from my body.no report said that doctor touch any part of my ovaray its very clearly shows that doctor just remove the cyst from my body which grows near ovaray thatswhy they said ovrain cyst .
q*.why they said ovarain cyst.?
ans. because cyst can be growing any part of body cyst is not particular dieses of ovaray only .cyst is itself a diease which can be found any part of body.so if star health insurance co want to said cyst diease means ovarain diesase kindly tell them to write in email .i ask this question somany time i can send you email but (they never reply about that).
q*.why indian all major health insurance company mention about cyst diease in policy wording seprately and very clear.?
answer. as they try to said cyst is particuler diseas for ovary only and cyst is not grown any other part in humen body so my question is why all major insurance company mention about cyst diease very clearly in policy documents.(they never answer )if you needed i can provide you prove.
q*.why star health insurance did not mention about cyst diease clearly.?
answer. as my question they did not menation about cyst diease is not cover within * years of policy duration so how they reject my claim because i undergo for cyst removal operation and it should be cover by star health insurance company because it is not written in exclusion part of policy documents which i got from star health insurance company. (i can provide you prove).

i am very hopeful with consumer forum and indian law to i get justice in this case and i kindly request to you please take action fast .i will be very grateful if take necessaries action against star health insurance company .

best regards
nikhat bano
mob.**********
jamshedpur jharkhand
my policy no.p/*****/**/****/******
my card no.********-*
my intimation number. *******

i like to appoint person who will take all necessory action in behalf of me is.
*. khursheed alam mob.**********
*. irshad ahmed khan mob.**********
*. md fardeen khan mob.**********




details of requester



name: - nikhat bano
mob.**********
h.no.** cross road no ** road no ** zakir nagar east
p.o. azad nagar near shiya masjid mango jamshedpur ******.
case againest: - star health insurance co
total amount: approx. ***** rs
reason for case filling: rejection of claim by wrong reason
health insurance policy no. p/*****/**/****/******
sum insured: - ****** rs