[Resolved]  Icici Lombard — Claim Rejection on false grounds, Claim ref#[protected]/00/001-M045426.06

Address:

Ludhiana, Punjab

Dear Consumer Complaints review team, Firstly thanks for creating such a forum for general public to post their grievances. Well appreciated!! My mother got hospitalized in Sydney on 17-Mar-14 for breathing problems. After detailed tests & examinations in Emergency department, doctors diagnosed her with a heart failure and chronic kidney problems (CKD). Luckily she was travelling with cashless travel insurance policy from ICICI Lombard which had a limit o[censored]SD $100, 000. We lodged the claim with ICICI and submitted all documents as requested by the insurer, after detailed review of all medical reports & contacting my mother's regular doctor in India, they accepted the claim and Australian hospital was placed a guarantee “in writing” that “Claim is Medically Admissible” and will be paid by ICICI Lombard upon receiving final invoice. After 16 days of hospitalisation, my mother got discharged and 2 weeks later, i flew her back to India for further treatment at Medanta hospital in Gurgaon and to avoid further medical bills in Australia. In the mean time, we also submitted all medical reports and invoices for settlement to the insurer. After 2 months of reviewing, ICICI informed us that claim is “Rejected” as her kidney problems were pre-existing. So ICICI changed their mind after looking at invoices of worth AUD $32, 000 (Approx. USD $30, 000/ Rs 17 Lacs) and found a reason to reject the claim. ICICI clearly took 2 months to search hard through all reports just to find a reason for rejection. The rejection was based on medical reports issued by Medanta hospital in India for mum's treatment after her return to India whereas the claim was related to Australian hospital. One of the medical reports issued by Medanta had an error stating that mum is suffering from kidney problem from last 2yrs whereas Australian medical reports clearly stated that her kidney & heart problem is newly diagnosed. Anyways, we took up this mistake with Medanta and they told us this is a common problem with insurance companies in India. As suggested by them, we submitted an Affadavit to them and they issued us an certificate after through review of reports. The certificate said that the patient is not suffering with CKD from last 2yrs instead since 17/3/14 (date of hospitalisation in Sydney). I forwarded the Medanta certificate to ICICI and requested for re-assessment. Along with that certificate, I also attached all the proof documents to support the claim like Australian medical report, My mother's 2 yr old Australian medical report, Pre-history report signed by mother's physician in India which they already had with them. I submitted all these documents on 26/July/14. It's been more than 5 weeks now but so far they have not replied to me. Whenever i call them for follow-up, they tell me that this is under review with higher management. Honestly this claim is becoming harassment for my family now in India and in Australia. I don't know why an honest person has to still stay deprived from his rights in India. Such incidents are bringing so much bad name that even Indians like me don't want to live in India, who else can we expect to come and settle here. I don’t know when we will get justice in this matter but on behalf of my mother, i request this forum to kindly come forward and help the genuine person. Thanks Nikhil Malhotra (Australia) Email: [protected]@yahoo.com Vijay Kumar Malhotra (Ludhiana, Punjab) +91-[protected]