When 29-year-old Purvi Gupta was diagnosed with Deep Vein Thrombosis (DVT) earlier this year, her family assumed their health insurance would step in as support.Instead, they say they found themselves navigating months of repeated document requests, shifting explanations, and, eventually, a fraud allegation they say they learnt about only after IndiaToday.in reached out to Star Health with questions.Purvi was admitted to Parashree Speciality Hospital in Amaravati, Maharashtra, late on February 17, 2024. Her brother, Nikhil Gupta, says he informed Star Health the next afternoon, within the mandated 24-hour intimation window. The insurer acknowledged the notification and issued a claim number.The Gupta family has been insured with Star Health since 2017, while Purvi’s own policy began in 2021 with a Rs 5 lakh cover and an annual premium of about Rs 6,000..preferred-source-banner{ margin-top: 10px; margin-bottom:10px;}This was their first-ever claim. The amount they sought was modest at around Rs 52,000, including roughly Rs 34,000 in hospital charges and the rest for radiology tests and medicines.According to Nikhil, the claims process quickly became a loop. Documents were submitted, then sought again. Case papers, clarification notes, hospital records, and declarations were emailed repeatedly and later submitted physically as well. Each follow-up call, he says, connected him to a representative who had no knowledge of previous conversations.By March, the family received their first communication saying the claim “could not be admitted” due to incomplete documentation. Over the next several months, the same papers were requested repeatedly, Nikhil says, despite acknowledgements from the insurer.Five months after intimation, on July 18, the claim was still pending.On September 18, the company issued a final rejection, again citing “non-submission of required documents”. At no point, according to the family, was any other reason mentioned.INSURER ALLEGES FRAUDAfter IndiaToday.in reached out to Star Health for comment, the insurer issued a formal statement offering a very different explanation.Star Health said the claim was rejected because it was found to be an attempted fraud. It alleged that the discharge summary submitted by the family was “forged,” citing what it described as mismatched patient details, overwritten entries, manipulated dates, and a format inconsistent with the hospital’s standard documentation.The insurer said its investigation team concluded that documents had been fabricated.Star Health added that it maintains a zero-tolerance policy for fraudulent claims and pointed to its claim settlement record, stressing that it pays genuine claims promptly. It also referred to rising instances of document manipulation across the industry.When contacted again with the policyholder’s rebuttals, Star Health said it would not issue any further statements.‘IF IT WAS FRAUD, WHY WASN’T I TOLD EARLIER?’Nikhil Gupta strongly disputes the fraud allegation.“All the documents had the hospital’s seal and the authorised signatory,” he said. “If they believed it was forged, why was it never told to us? Why was it not mentioned in any rejection letter?”Nikhil shared a copy of the discharge summary with IndiaToday.in. It carries the hospital’s seal and the signature of the treating doctor. The family says this is the same document they submitted to the insurer.He says the discharge summary clearly states his sister’s name and age, which he maintains are accurate. The insurer’s point about handwriting consistency, he says, does not prove manipulation. “Hospitals often have the same staff writing notes across shifts. That is normal.”He also questions whether the insurer is implying the hospitalisation itself did not occur. “The Doppler test confirming the clot was done at an external radiology lab. That report is genuine. Are they saying that is fake too?”According to him, every document request was complied with, both digitally and physically. He shared stamped acknowledgements from branch submissions. “Even then they said it was non-submission,” he said.What unsettles him most is the timing. “For months I was told only that documents were pending. If it was fraud, why was the insurer silent about it until now?”Nikhil says he is considering approaching the Insurance Ombudsman but is wary of the long timelines such cases typically involve. “We already have a civil case running for 29 years. I cannot afford another one that might take decades.”FLAWED SYSTEMIndustry experts say the experience described by the Gupta family reflects gaps that extend beyond a single case.Shilpa Arora, co-founder and COO at Insurance Samadhan, told IndiaToday.in that repeated document requests and prolonged delays are becoming increasingly common across insurers.“Families often end up submitting documents multiple times, only to be told they still have not been provided,” she said. “It raises the question of whether these delays stem from systemic inefficiencies or operational practices that defer resolution until the Ombudsman stage.”Arora recommends that policyholders maintain a clear documentation trail by emailing submissions, sending physical copies when required, and keeping delivery receipts.“If a claim remains unsettled beyond 30 days, it should be escalated to the insurer’s Grievance Redressal Officer and registered on the Bima Bharosa platform,” she said.“If there is no satisfactory response within the next 30 days, it should be taken to the Insurance Ombudsman. In many such cases, claims are resolved before the hearing.”WHERE THE CASE STANDS NOWThe claim remains rejected. Star Health maintains that it was a fraudulent submission.The Gupta family insists that all documents were genuine and says the fraud allegation was never communicated to them during the claims process.Nikhil now plans to approach the Ombudsman after the insurer’s fraud charge.(Disclaimer: IndiaToday.in has reviewed documents submitted by both the policyholder and the insurer’s statement but cannot independently verify medical records or internal investigation findings. The story will be updated if regulatory bodies or the Ombudsman issue any final determination.)- EndsPublished By: Koustav DasPublished On: Dec 3, 2025

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