In a troubling incident that highlights the flaws within the insurance sector, a distressed policyholder recently faced an ordeal with Care Health Insurance Co. Ltd. when trying to claim benefits for his elderly father’s health insurance. This case exposes the serious lapses in Care Health Insurance’s claim handling, transparency, and ethical practices.
The Policy Purchase
The policyholder, a devoted son, sought a health insurance plan for his elderly, low-educated father who could barely write his own name. With careful research, he selected Care Health Insurance and was soon contacted by their sales team. After detailed discussions, he agreed to purchase the "Care Supreme" plan with an “Instant Cover” add-on, which promised to waive waiting periods for certain listed diseases and declared pre-existing conditions. Trusting the insurer’s promises, he paid the additional premium and the policy, numbered XXXX, was issued on January 18, 2024.
The Accident and Initial Treatment
On June 26, 2024, the family’s life took an unfortunate turn. While traveling, they were involved in an accident that left the father with injuries requiring immediate medical attention. He was rushed to a local hospital, where he received initial treatment and was discharged the same day. Although his condition seemed stable at first, he later developed severe chest pain, prompting his son to take him to ABC Central Hospital for further evaluation. There, doctors recommended immediate hospitalization to treat the chest pain caused by the accident.
A Chaotic Claim Process
Upon admission, the hospital promptly sent a pre-authorization request to Care Health Insurance, seeking approval for the treatment. However, the insurer failed to respond within the required time frame, leaving the family in a state of uncertainty. Despite multiple follow-ups from the hospital’s TPA desk, there was no response from Care Health Insurance.
On July 3, 2024, without prior notice or consent, an investigator sent by Care Health Insurance arrived at the hospital. The investigator met with the elderly patient, who was under the influence of heavy medication and in a vulnerable state and obtained signatures on unspecified documents. This interaction took place without any communication with the attending physician, the medical staff, or the policyholder himself. The investigator’s actions were not only unethical but also in violation of the patient’s rights and dignity.
Claim Denial and Policy Cancellation
The following day, the hospital received a shocking letter from Care Health Insurance: the claim was denied on the grounds of "NON DISCLOSURE OF MATERIAL FACTS/PRE-EXISTING AILMENTS AT TIME OF PROPOSAL—OSA SINCE 1.5 YRS." This denial was based on unproven assumptions and lacked any supporting medical evidence. The policyholder, in disbelief, attempted to escalate the matter but was advised to file a reimbursement claim after discharge.
Despite following these instructions and filing the reimbursement claim, it was summarily rejected on July 17, 2024. Adding insult to injury, Care Health Insurance canceled the policy and forfeited the premium, further alleging non-disclosure of obstructive sleep apnea (OSA) in the proposal form—an accusation entirely unfounded and baseless.
Conclusion
This distressing experience with Care Health Insurance Co. Ltd. brings to light the serious flaws in how insurers handle claims, particularly in times of need. The policyholder’s trust in the system was betrayed, resulting in financial hardship and emotional turmoil. Care Health Insurance's failure to honor its commitments and its unethical conduct during the claim process have raised significant concerns about the practices within the insurance industry. This case serves as a stark reminder of the need for greater accountability and reform to protect policyholders from such unfair treatment.
Disclaimer: This blog is based on the written complaint and evidence submitted by the complainant to the insurer. It is intended solely to present the facts and issues raised by the complainant regarding their experience with the insurer. All personal details of the complainant and other sensitive information have been made discreet to protect privacy. There is no intention to defame or malign any individual or organization mentioned herein. The insurer is committed to resolving grievances and improving their services. This blog aims to raise awareness about current insurance practices and highlight areas for potential improvement, not to discredit or disparage any party involved.
For this fraud they should be punished
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