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The woman’s daughter said that the family was forced to pay Rs 1.3 lakh out of pocket after Care Insurance rejected her mother’s claim as “fraud”.
The woman’s mother was hospitalised for three days due to breathing problems. (Representative image/Getty)
An elderly woman, insured by a health insurance company, was hospitalised for three days due to severe breathing problems. Before she was discharged, the family filed a claim for the medical expenses. However, the claim was rejected as “fraudulent” via a PDF sent over WhatsApp. Despite repeated attempts to contact the company through emails, the family’s queries went unanswered.
Frustrated and distressed, the woman’s daughter took to X (formerly Twitter) to highlight the harassment her family endured, adding that they were “forced to pay ₹1.3 lakh” out of pocket due to the rejected claim.
“My elderly and unwell parents are facing unbelievable mental, financial and physical harassment from Care Insurance to whom they pay high annual premium since 2023. My mother, insured under Care, was hospitalised at Fortis with severe breathing problems on 20 January on urgent advice of doctor for days,” wrote Rituparna Chatterjee on X.
She explained that the hospital submitted all the documents the insurance company had asked for, but still their claim was rejected. “…On Jan 22, just before her discharge, my father got a pdf letter via Whatsapp – no formal email – that our claim was rejected as a ‘fraudulent claim’,” she added.
“No official explanation given. Mails going unanswered. Their whatsapp helpline is a joke. Customer executives mostly put us on hold and we have been given three different versions verbally by different executives (one said claim was rejected because my mother is a smoker!),” Chatterjee, a journalist with The Independent, went on to say.
She further said that the health insurance company later claimed the rejection was due to “non-submission of documents” but refused to specify which “documents they need”. She added that even the doctor is furious as her mother’s claim was “genuine”.
Since the claim was rejected, the family had to pay Rs 1.3 lakh out of pocket. “Rs 1.3 lakh is not an amount we could afford but were forced to + no guarantee that Care won’t keep rejecting our claims in future. It’s extremely scary as now my stressed and devastated parents are afraid every hospitalisation will come out of pocket. The stress is making her (mother’s) health worse,” she further expressed.
“What is batshit crazy is it’s been over 24 hours and we still don’t know the reason for rejection. Their executives keep saying please mail to cashless at careinsurance dot com,” Chatterjee wrote as she shared a screengrab of the email she received.
The email reads, “Please note that we will no longer be accepting cashless requests via email. Therefore, this request cannot be processed.” It further instructed the customer to submit all cashless requests through the company’s portal or contact the regional manager.
While sharing yet another screengrab, she wrote, “Their insulting mail today. No one can be reached in Care Insurance. They won’t explain what is fraudulent about her claim, calling us frauds without any further explanation. Won’t give any details. Doctor saying pursue this at the highest level as this is absolutely horrifying.”
The email mentions that the cashless claim was rejected as the “fraudulent claim”.
