29-year-old Purvi Gupta faced challenges with her health insurance provider, Star Health, after being diagnosed with Deep Vein Thrombosis (DVT) earlier this year. Despite notifying Star Health within the required 24-hour window upon admission to Parashree Speciality Hospital in Amaravati, Maharashtra, the Gupta family encountered a prolonged and frustrating claims process.
Having been insured with Star Health since 2017, Purvi’s policy, initiated in 2021 with a cover of Rs 5 lakh and an annual premium of around Rs 6,000, was being utilized for the first time. The family sought a modest claim of approximately Rs 52,000, encompassing hospital charges, radiology tests, and medication expenses.
Nikhil Gupta, Purvi’s brother, detailed the repetitive nature of the claims procedure, involving multiple document submissions and requests, leading to delays and confusion. Despite continuous efforts to fulfill documentation requirements, the claim remained pending for five months before being ultimately rejected on grounds of inadequate document submission in September.
Responding to inquiries from IndiaToday.in, Star Health alleged fraudulent intent behind the claim rejection, citing discrepancies in the submitted discharge summary, which they claimed was forged. The insurer emphasized its commitment to combating fraudulent activities and highlighted its swift processing of legitimate claims.
In contradiction to the fraud accusation, Nikhil provided a copy of the discharge summary bearing the hospital’s seal and doctor’s signature, asserting the authenticity of the submitted documents. He refuted Star Health’s claims of manipulation, pointing out the clarity of patient details in the summary.
Expressing disbelief at the sudden fraud allegation after months of document-related communications, Nikhil contemplated seeking intervention from the Insurance Ombudsman, although he expressed concerns about potential prolonged legal proceedings.
Industry experts, including Shilpa Arora from Insurance Samadhan, highlighted the systemic inefficiencies and delays in claim settlements experienced by many policyholders. Arora recommended maintaining a meticulous record of document submissions and escalating unresolved claims through proper channels to expedite resolutions.
As the situation stands, the claim remains rejected, with Star Health maintaining its fraud stance, while the Gupta family insists on the authenticity of their submissions. Nikhil intends to pursue recourse through the Ombudsman following the insurer’s fraud allegations.