Consumer Complaint Against Star Health and Allied Insurance Co. Ltd. for Deficiency in Service and Unfair Claim Handling in Claim No. 0384442

Gaurav8940

Gaurav8940

New member
Policy Name
Star women care insurance
Company Name
Star health insurance
Customer Care Number
04469006900
Loss Amount
300000
Ratings
1.00 star(s)
Opposite Party Address
Online
To
The President
District Consumer Disputes Redressal Commission
Patna


Subject: Consumer Complaint Against Star Health and Allied Insurance Co. Ltd. for Deficiency in Service and Unfair Claim Handling in Claim No. 0384442


Complainant:
Shanti Kumari
H. No. 51, Bhagirathi Lane, Mahendru, Near Malaria Office, Patna – 800001
Mobile: 9860885989


Opposite Party:
Star Health and Allied Insurance Co. Ltd.


Respected Sir/Madam,


I am filing this complaint against Star Health and Allied Insurance Co. Ltd. for deficiency in service, unfair claim handling, and causing mental agony and financial hardship during a medical emergency.


Facts of the Case:


  1. I purchased a valid health insurance policy (Policy No. P/700016/01/2025/016306_2025) from Star Health and Allied Insurance Co. Ltd.
  2. The insured patient, Shanti Kumari, was admitted to Jayprabha Medanta Super Speciality Hospital on 08 June 2026 for treatment of Fever of Unknown Origin.
  3. A cashless treatment request under Claim No. 0384442 was submitted to the insurer during hospitalization.
  4. After a thorough assessment of the cashless claim request (Claim No. 0384442) received on 08-06 at 20:45 PM, the insurer informed us that the cashless request was denied, stating that “liability cannot be ascertained at this stage.”
  5. Subsequently, upon contacting the claims department, I was informed that certain documents were required for claim assessment.
  6. If documents were required, the insurer should have raised a query and sought the necessary information from the hospital or insured. Instead, the cashless request was denied without giving any opportunity to submit the allegedly missing documents.
  7. Due to the denial of cashless authorization and inability to arrange substantial treatment expenses immediately, we were compelled to take discharge of the patient from the hospital, resulting in interruption of treatment, mental agony, and financial hardship.
  8. Despite approaching the grievance department, satisfactory relief has not been provided.

Grounds of Complaint:


• Deficiency in service.
• Failure to provide fair and transparent claim assessment.
• Failure to seek required documents before denying cashless authorization.
• Causing mental harassment and financial hardship during a medical emergency.
• Violation of the legitimate expectations of a policyholder who purchased insurance for emergency medical support.


Relief Sought:


I respectfully pray that the Hon’ble Commission may:


  1. Direct the insurer to review and process Claim No. 0384442 fairly in accordance with the policy terms.
  2. Direct the insurer to provide a detailed written justification for the denial of cashless treatment under Claim No. 0384442.
  3. Award compensation for mental agony, harassment, and inconvenience caused.
  4. Award litigation costs and other appropriate relief deemed fit by the Hon’ble Commission.
  5. Pass any other order in the interest of justice.

I declare that the facts stated above are true to the best of my knowledge and belief.


Place: Patna


Date: 08-03-2025


Complainant


(Signature)


Shanti Kumari
 

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