URGENT SISTER CLAIM REJECTED BY STAR HEALTH

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Deal Newbie
Just1ik3

I urgently need advice from experienced folks here. My sister's medical claim was rejected by STAR HEALTH, citing that the policy premium was missed. However, the premium was paid on time, but their system shows it was paid after the claim intimation, so they’re rejecting the claim, saying the policy wasn’t valid at the time.

I have all the receipts proving that the premium was paid before the claim. I’ve escalated this to the highest level within STAR HEALTH, but they keep saying nothing can be done. I even filed complaints with IRDAI and the Bimalokpal Ombudsman, but it’s been 5 months with no resolution. They keep saying the same thing.

This policy has been active for 8 years with timely premium payments every time. What can be done here? Going to court seems like it will only waste more time and money, and nothing will come of it. I wish there was something as powerful as the RBI Ombudsman for insurance, as IRDAI and the insurance ombudsman have done nothing so far.

Any advice or guidance would be greatly appreciated. Thanks in advance

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Commentator Commentator
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When was the premium paid exactly and when was the claim intimated to the company?
Commentator Commentator
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What is the policy beginning and end date in old and new policy document? You don't get insurance coverage before payment date and during the grace period.

Helpful Helpful
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Hiding something. Details missing.

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Wingman Wingman
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You can Go to consumer forum.

Deal Cadet Deal Cadet
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Consumer court takes time to solve a case, goes in months and years. He is asking for any help for the claim to be lodged and be served rightfully with his current policy.

Deal Cadet Deal Cadet
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You don't need to worry about if you have paid premium on time. Even your policy is valid since 8 years and you had paid premium without fail so far. Just raise a complain to consumer forum it will sort out shortly.

Commentator Commentator
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When was the premium paid exactly and when was the claim intimated to the company?
Helpful Helpful
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Ye kindly post collection receipt if possible and intimation details before asking for further help

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consumer forum

Deal Subedar Deal Subedar
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.

Commentator Commentator
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What is the policy beginning and end date in old and new policy document? You don't get insurance coverage before payment date and during the grace period.

Deal Cadet Deal Cadet
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I have star health policy and I get email with renewed policy PDF within 30 mins of paying premium (that too via 3rd party Amazon). Did you not get your policy PDF via email when you paid your premium?

Deal Subedar Deal Subedar
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As per OP, IRDAI and Insurance Ombudsman has been approached and they 'keep saying the same thing' for last 5 months. 

Question: Please elaborate what do you mean by  'keep saying the same thing'? Does that mean the Insurance Ombudsman decision was in favor of Star Health? If yes what reasons were cited?

Remember, this

  1. Insurance Ombudsman is accountable to make decision within 3 months.
  2. One cannot challenge Insurance Ombudsman's decision.


 If you have to go to Consumer Forum, you got to frame your case accordingly. 


Helpful Helpful
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Hiding something. Details missing.

Deal Subedar Deal Subedar
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Looks like he paid the premium minutes before making the claim. Maybe if it was by card which gets settled in a day or two, company is using that date to save itself. 

Generous Generous
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kahin to jhol hai , daya ko pata lagana padega

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