Nitya Pasari has filed a serious complaint against Care Health Insurance Limited for arbitrarily denying a valid claim and unlawfully deleting an insured member without notice. Published on Choice4Voice.com to highlight insurance-related consumer grievances.
Note: If this issue is resolved, the concerned brand or the complainant may contact us at support@choice4voice.com. After proper verification, we will either update this article as “Resolved” or delete it, ensuring fairness to both parties.
Complaint Summary : Care Health Insurance Complaint by Nitya Pasari – Alleged Unlawful Denial of Valid Insurance Claim
| Detail | Information |
|---|---|
| Complainant Name | Nitya Pasari |
| Company Involved | Care Health Insurance Limited |
| Complaint Type | Health Insurance Claim Denial & Policy Violation |
| Policy Number | 61662342 (Care Advantage + Care Shield, Sum Insured ₹25,00,000) |
| Claim Reference | 81920785-02 (Manipal Hospital, Mukundapur, Kolkata) |
| Date of Admission | 4th August 2025 |
| Primary Insured | Mr. Bijay Kumar Pasari |
| Key Allegations | – Arbitrary denial of valid claim during hospitalization |
Detailed Complaint
Nitya Pasari, an LLB graduate from Jindal Global Law School, has raised a serious grievance against Care Health Insurance Limited for denying a valid health insurance claim under questionable circumstances.
According to the complaint, despite paying hefty premiums for three years, her family’s insurance policy was arbitrarily restricted during a medical emergency. The claim (Ref: 81920785-02) was denied for hospitalization at Manipal Hospital, Mukundapur, Kolkata on 4th August 2025.
Key concerns highlighted include:
- No closure letter or justification for claim rejection.
- Wrongful deletion of an insured member (the complainant) from the policy without notice or consent.
- Unfounded rejection on BMI grounds despite valid medical records.
- Labeling the complainant as “fraud” – causing reputational harm and mental harassment during treatment.
Nitya further points out that her earlier hospitalization in February 2025 under the same policy was fully covered cashlessly, which makes the current denial arbitrary and inconsistent.
Legal & Regulatory Violations Alleged
The complainant has cited multiple breaches:
- Consumer Protection Act, 2019 – Deficiency in service and unfair trade practice.
- Principle of Utmost Good Faith – Breach of foundational insurance contract obligation.
- Unfair Trade Practice (Sec. 2(47), Consumer Protection Act) – Arbitrary denial and policy tampering.
- IRDAI (Health Insurance) Regulations, 2016 – Non-compliance with fair, transparent, and timely claims settlement rules.
- Contract Law & Principles of Natural Justice – Wrongful deletion of insured member without due process.
Statement from the Complainant
In her LinkedIn post, Nitya Pasari stated:
- “Despite paying hefty premiums for three years, I have been wrongfully denied cashless treatment on arbitrary grounds.”
- “I have been deleted as an insured member without notice, which is patently illegal.”
- “This conduct constitutes deficiency in service, breach of contract, and unfair trade practice.”
- “Shockingly, I am being labelled as fraud during hospitalization – causing defamation and mental harassment.”
- “If immediate rectification is not provided, I will pursue legal remedies for breach of contract, harassment, and violation of consumer rights.”
About Care Health Insurance
Care Health Insurance Limited is a leading private health insurer in India offering individual, family, and corporate medical coverage. However, cases like this highlight serious concerns about arbitrary claim rejection, unfair trade practices, and policyholder rights violations.
Key Issues Raised
- Wrongful denial of valid insurance claim.
- Lack of transparency – no written closure or explanation.
- Unlawful deletion of insured member from active policy.
- False labeling as fraud – amounting to defamation.
- Violation of IRDAI guidelines and consumer laws.
Choice4Voice.com – Standing with Policyholders
At Choice4Voice.com, we raise consumer complaints against companies that fail to honor commitments. Insurance is meant to provide security in times of medical crises, and wrongful denial of claims undermines public trust.
Frequently Asked Questions (FAQ)
Q1. Who filed the complaint against Care Health Insurance?
A: Nitya Pasari.
Q2. What was the policy involved?
A: Policy No. 61662342 (Care Advantage + Care Shield, ₹25,00,000 sum insured).
Q3. Who was the primary insured?
A: Mr. Bijay Kumar Pasari.
Q4. What was the claim reference?
A: Claim Ref: 81920785-02 (Manipal Hospital, Mukundapur, Kolkata).
Q5. What date was the patient admitted?
A: 4th August 2025.
Q6. On what grounds was the claim denied?
A: Allegedly on BMI-related grounds, which the complainant disputes as unfounded.
Q7. Was any closure letter issued?
A: No, according to the complainant, no closure letter or justification was provided.
Q8. What illegal step was taken by the insurer?
A: Deletion of the insured member without notice or consent.
Q9. Has Care Health Insurance responded to this complaint?
A: No response has been reported so far.
Q10. Which law protects the complainant’s rights?
A: Consumer Protection Act, 2019 and IRDAI regulations.
Q11. What legal remedies are available?
A: Filing with IRDAI, Consumer Forum, and civil courts for damages and breach of contract.
Q12. What mental harassment is alleged?
A: Being falsely labelled as fraud during hospitalization.
Q13. Was the policy active during hospitalization?
A: Yes, premiums had been paid for three years.
Q14. Was the same policy used before?
A: Yes, in February 2025 the same policy covered hospitalization cashlessly.
Q15. What principle of insurance was violated?
A: The principle of utmost good faith.
Q16. Can an insured be removed without consent?
A: No, removal without notice is unlawful and against IRDAI regulations.
Q17. What constitutes unfair trade practice in this case?
A: Arbitrary denial of claim and wrongful deletion of coverage.
Q18. What action has the complainant sought?
A: Immediate reversal of denial and restoration of coverage.
Q19. What regulatory body can intervene?
A: Insurance Regulatory and Development Authority of India (IRDAI).
Q20. How does Choice4Voice.com help policyholders?
A: By publishing genuine complaints to pressure companies and ensure accountability.
Choice4Voice.com Is Here to Help You
If you are facing a similar issue and would like our support in highlighting your concern, we are here to assist.
Simply write a LinkedIn post and tag our official page Choice4Voice.com
Submit your complaint directly : https://choice4voice.com/submit-your-complaint/
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