Harassing us by declaring coronary artery disease to my father

[shubham goyal]

Policy Name

family floater scheme

Company Name

Care health insurance

Loss Amount

180000

Ratings

5.00 star(s)

Opposite Party Address

vipul tech square 3rd floor towel c sector 43 Golf course road gurugram 122009

My father had a pain in his left hand in July 2021 so our physician advised us ECG which showed abnormal results so he advised us cardiologist which further suggested us to get admit. On performing several Echo and angiography, he discharged my father saying he is fine and no medicines and follow up were advised. No stents were there, even angiography clearly states NORMAL EPICARDIAL CORONARY ARTERIES. We purchased insurance in December 2021 and our problem was diagnosed in 2022 January that my father has Spinal TB and it was operated on 12th January 2022. Earlier this year in 2024 we have to remove implants on our doctor advice and we have ask for claim for the same but our insurance company is rejecting our claim by stating non disclosure of pre existing disease. We don't have any if there was any my father has undergone 2 spinal operations. Both will not be done if we don't have cardiological clearance. Even we applied to Insurance ombudsman for the same and the award was in our favour, even after that company rejects our claim stating the same reason. My father is now in depression that if i dont have any problem why they are making me the patient of heart. I am attaching the insurance ombudsman award which briefly explain all my problems.
Please provide justice to me in this.

 

[TeamMember]

Hello @shubham goyal Ji,

We have checked the attached document, and found the details mentioned on the last page.

AWARD
Taking into account the facts and circumstances of the instant case, perusal of available documents and the submissions made by both the parties during hearing, it is directed that the Insurer re-examines the subject reimbursement claim once again filed for Rs. 1,85,000/- by the complainant and settles the genuinely admissible and payable claim on merit, supported by relevant and requisite documents/papers as per the Terms & Conditions of the policy to meet the ends of justice in the instant case.

Accordingly, the complaint is disposed off.

In your case, the Insurance Ombudsman directed the insurance company to re-examine.

If the insurance company is not giving the claim, we suggest you to file a Consumer Case in your nearest Consumer Forum.