Icici Lombard — Health influence claim rejected

Address:New Delhi, Delhi

Cashless claim rejected[protected] stating that it cannot be covered as per the disease sublimit. I took a policy of 3 lacs and it was never mentioned at the time of taking this policy that hospitalisation not involving surgery should not exceed more than 25k. It was never mentioned to me at the time of policy purchase, they are cheating people when they have to use the policy. Patient name - Avadh Gupta UHID[protected] Class of accommodation - ICU Date of admission -12 September 2015 My name is Shweta Gupta phone number [protected]. Appreciate quick help to resolve the matter.
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ICICI Lombard customer support has been notified about the posted complaint.
Sep 13, 2015
Updated by ShwetaGupt
Subject line should Health insurance claim rejected
Complaint comments 

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Dear Shweta,


We have made a note of the details mentioned. We will check this from our end and get back to you with an update.

Regards,
ICICI Lombard General Insurance
Dear Shweta,

AL enhancement:[protected]
Requested amt : 38260
AL status : Rejected
Remarks : Others - Kindly note as the disease sub limit available under the policy has been exhausted, hence further enhancement of limit is not approved. During final settlement of claim, any excess amount that has been approved at the time of initial authorization or subsequent limit enhancement, discounts and expenses incurred on non-medical expenses shall be deducted. Final claim settlement will be done strictly as per the terms and conditions specified in MOU.

As per policy certificate customer opted Sub limit “C” Please refer below sub limit table as per current product.

And current ailment “Other specified fever” falls under “All Medical Expenses for any treatment not involving surgery/ medical procedure”. Therefore our liability for said ailment is Rs. 25000/-for each Hospitalization


Note : the reason for sanction Rs. 25000/- for two admission is :

As per policy the sub-limits mentioned above shall be applicable for each Hospitalization. For the purpose of applicability of the said sub-limits, multiple Hospitalizations pertaining to the same illness or medical procedure / surgery occurring within a period of 45 days from the date of discharge of the first Hospitalization shall be considered as one Hospitalization.

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