Icici Lombard — Health insurance - company not following their own terms

Address:	Mumbai City, Maharashtra, 400078
Website:	www.jio.net.in/jio-phase-1-renewal

Recpected sir / madam,

Please find my details below:

My name is nilesh gala.
Claim no. :[protected]
Interaction id :[protected]
Uhid : ilgic/2hn/00/[protected]/s
Policy amount : 5, 00, 000
Claim amount : 2, 79, 368
Approved amount : 1, 25, 000
Surgery : hip joint replacement surgery.

I have a group mediclaim policy of icici lombard through jio (Jain international organisation).

I have undergone a hip replacement surgery with a reimbursement claim of rs. 2, 79, 368. But icici lombard is approving only rs. 1, 25, 000 saying that in their terms and conditions there is a cap of 125000 for joint replacement.

Please find below image and the attached file. In their terms and conditions they have very clearly mentioned that there is a cap of 1, 25, 000 for knee replacement but now they are saying that it is a mistake from their end and actually it is for joint replacement.

If you go on jio's website at below link it is clearly mentioned that there is a cap for knee replacement only and not for hip replacement.

http://www.jio.net.In/jio-phase-1-renewal/

I feel cheated by icici as i have paid the premium to them and it is their responsibility to settle full claim as all the documents sent by me are proper and approved by their claim team.

I being still ill am following up with them since last 10 days, calling them again and again.

The claim team is accepting the mistake but they are not ready pay the full claim amount.

They are also not ready to send it in mail that it is a mistake from their end and they will not pay the balance amount of rs. 1, 54, 368.

I have call recordings of all my communications with them.

Please help in getting this solved.

Nilesh gala

[protected] / [protected]