Care Health Insurance Rejects Valid Claim: A Policyholder's Unfortunate Experience

 

Care Health Insurance Rejects Valid Claim: A Policyholder's Unfortunate Experience

Health insurance is an essential investment for safeguarding your family's health and finances. However, issues can arise, as exemplified by the unfortunate experience of an anonymous policyholder who recently wrote to their insurer, Care Health Insurance. In October 2020, the policyholder purchased a health insurance policy, Care Advantage, for their parents via Policybazaar.com, with an annual premium of ₹64,485.20. During the policy proposal stage, they shared all the pre-existing medical conditions of both their parents to the best of their knowledge. A pre-issuance medical examination was conducted for the father, and the insurer acknowledged the pre-existing diseases of asthma and diabetes. The insurer waived the premium for asthma and diabetes under their agreement with Policybazaar.com, and the policy was issued without any underwriting extra loading.

The policy was active, and all premiums due were paid promptly, and it covered both parents from October 6th, 2020. In October 2022, the father accidentally slipped and fell, and was advised to undergo surgery. A cashless claim was filed on October 15th, 2022, but the insurer rejected the claim after almost a week, citing the reason "NON-DISCLOSURE OF MATERIAL FACTS/PRE-EXISTING AILMENTS AT THE TIME OF PROPOSAL (K/C/O-ASTHMA)." The policyholder was disheartened, and after following up with the insurer and Policybazaar.com, they had no choice but to pay the hospital bill of around ₹2,62,296 from their own pocket.

Upon checking the policy cover note issued by Care Health Insurance, the policyholder found that the pre-existing ailment of asthma had been duly acknowledged by the insurer itself. When the policyholder contacted the insurer's contact center, they confirmed this fact and requested that they submit the reimbursement claim along with all relevant case papers and medical reports for the claim's approval.

However, when the policyholder tried to file an online claim against their policy, the system did not allow them to do so. Upon contacting the contact center, they were informed that their policy had been canceled by the insurer. The policyholder requested a refund of the premiums paid against the policy, but the insurer refused, stating that due to the modifications made under the policy, it was immediately canceled, as no modifications are allowed in the policy post-issuance.

This unfortunate experience highlights the importance of reading and understanding the policy's terms and conditions carefully. It also underscores the significance of disclosing all relevant medical information truthfully during the policy proposal stage, as non-disclosure of material facts could lead to claim rejection. Moreover, it raises concerns about the insurers' practices and their commitment to serving their customers. Insurers should ensure that their customers' needs are met and provide a clear and transparent claim settlement process.

Disclaimer: The blog is based on the written complaint, supported by evidence submitted by the victim to the insurer. There is no intention to defame anyone named in this blog. The insurer also works relentlessly towards resolution of grievances, and we highlight these cases just to make others aware of prevalent insurance practices.