Care Health Insurance - Insurance company Care Health Insurance denied a legit claim

****************** Complaint - *******************
Complaint for Pushpa Bhatia (Primary Policy Holder)

Policy Details:
"Care Insurance" Health Insurance Policy no. ********. A Joint policy and Insured person: Pushpa Bhatia (Primary) & Braham Bhatia


Claim For Pushpa Bhatia:

Mrs. Pushpa Bhatia underwent Cataract operations on **-Nov-****.


 Without any cancellation notice or any valid reasons Insurance company did not accept claim intimation for Pusha Bhatia and stated “Claim is cancelled”

This is highly disappointing as whenever we are looking help from Insurance company, they just look for reasons to deny our claims. But they happily take annual premiums and are happy when no claims are made to them.

Please ref. following documents:

*. This is claim document for Pushpa Bhatia. ~Rs ***** - May ****
Claim * - Pushpa Bhatia - Doc *-A.PDF

*. Claim - * - Gmail - Fwd_ Urgent Claim Intimation for Cataract Eye Operation- Policy No. ********.PDF
This is Email proof where Insurance company denied our claim intimation.



****************** Complaint - *******************

Complaint for Braham Bhatia (Joint Policy Holder)

Policy Details:
"Care Insurance" Health Insurance Policy no. ********. A Joint policy and Insured person: Pushpa Bhatia (Primary) & Braham Bhatia


Claim For Braham Bhatia:

Initial claim in May **** rejected by Insurance company. The stated reason as:
 “Patient had a medical history of coronary artery disease & Brain Hemorrhage prior to policy inception with us which was not disclosed at the time of Proposal processing stage" Dates of interaction with insurance company is from May **** till now.

Mr. Braham Bhatia underwent treatment from May **** to November ****. But all claims for Braham Bhatia are either denied or on hold where we cannot submit them in the system because Insurance company have cancelled our policy.

Defending arguments for Braham Bhatia:

*. We have been genuine customers, consistently paying our annual premium on time for over * years. During this period, we have not submitted a single claim to the insurance company.

*. In reference to the comment regarding the 'medical history of coronary artery disease and Brain Hemorrhage prior to the inception of the policy with us, which was not disclosed during the proposal processing stage,' it is important to highlight that our policy has been in effect for over * years now. Furthermore, this policy is transferred from one provider to another in these * years. At the time "Care Insurance" transitioned our policy from the previous provider, there was no proposal submitted to us where we could fill in details of previous medical history. This situation represents a shared oversight, and it is unjust to place the entire burden of responsibility on the policyholder, who should not be the sole party facing the consequences. The insurance company also bears equal responsibility in this matter, as they are accountable for ensuring continuity of benefits when transferring policies between providers. Therefore, the oversight during the policy transfer is also a failure on the part of the insurance company.

*. The current eye treatment Mr. Braham Bhatia underwent *is not at all related* to his ‘medical history of Coronary Artery Disease & Brain Hemorrhage'.

*. In the policy document (page *, Table point **), it is clearly mentioned that the wait for pre-existing diseases for any claim is '** Months'' (ref below). Here in this case, neither the current treatment is related to pre-existing medical history. Moreover, if at all insurance company are linking it for any reason, then also the policy holder is loyally paying all premiums to you for more than * years now. It is only the matter of miss that is a joint responsibility and Insurance provider is equally responsible as well.

The claims that are on hold where we cannot submit them in the system because of insurance company sluggish system are:

Please ref. following documents:

*. Cataract Operation for Mr. Braham Bhatia: ~Rs ***** - May ****
Claim * - Braham Bhatia - Doc *-A.PDF

*. Correction of Eye further as suggested by doctors: ~Rs. **** -- July ****
Claim * - Braham Bhatia -Doc *-A.PDF



*. Cornea transplant as suggested by doctors: ~Rs. *,**,*** -- August ****
Claim * - Braham Bhatia - Doc *-A.PDF

*. Email interaction with Insurance Company:
Claim * - Gmail - Re_ ******* - Re_ Complaint against Claim Rejection CL No_ ********-**.PDF


****************** Complaint - *******************

Since the policy is cancelled, and we are not able to renew the policy with Care insurance.
At this old age, we need Health insurance policy now than ever before. We need to renew our insurance policy along with Continuity benefits.



Total claim amount for both Mr. Braham Bhatia and Mrs. Pushpa Bhatia is for Rs. ***,***. In adjacent to help in settling our claim, please help insurance company to renew our policy for Year ****-**** for both of us and provide the insurance continuity benefits, since our policy is active for more than * years now.




Date: December **, ****


Policy Owner: Mrs. Puspha Bhatia Spouse: Mrs. Braham Bhatia





Signature: Signature: