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[Resolved]  Royal Sundaram Health Insurance — Refusal Of Claim on false grounds

3rd Reminder


Kind Attn. Mr.Ajay Bhimbat,
Managing Director,
Royal Sundaram

Dear Mr Bhimbat,

RE POLICY # HO OOOO[protected] CLAIM HR 00028464

I take this opportunity to put to your kind attention that i am a policy holder for the last 3 years and never taken any claim against the policy. Since the last 2 years i started getting some pain in my legs and back, slowly it started progressing during walking. and i was prescribed pain killers etc. The pain started getting worse and upon investigation was diagnosed with ostoperosis arthertis.

I was advise a hip replacement surgery and underwent the same at Max Institute in New Delhi. Now it was the time to apply for my claim as a right because this is what we insure ourself for. Any eventuality etc etc. Right from the start first they refused the cashless facility suggesting me to go for reimbursement. The mental and financial agony caused to me on account of the refusal just before my operation was not enough as when i applied for the reimbursement that was also refused on flimsy grounds that it appears to be a pre existing condition. It is clearly unfair to handle patients aking for relief in this manner. Would i have waited to take a insurance claim for 3 years and then get myself treated? My physical condidion is much more important to me than financial matters. It is a trauma going through surgery but this financial burden added to it.

What is the use of getting Insured when your officers are insensitive and unjust to genuine claims. I wish to express my regret and unhappiness over this episode and request you to kindly depute a responsible person to take care of my claim in a right and just manner.

Your intervention would be very much appreciated in this regards.
Thank You
Best Regards
Rajive Sharma
Complaint marked as Resolved Aug 13, 2020
Complaint comments  6 CommentsShareTweet


I have had a similar experience with these people. I think Royal Sundaram is a very unreliable insurance company and we cannot play with the security of our lives with them.
Pl give suitable telephone no. I've also applied for post hospitalistion insurance thru royal sunderam health insurance. Pl send all details about he policy on my mailing address
I fully agree.How can a pre-existing condition denote anything with symptoms during the last 4 years.Why is this condition never mentioned before selling the policy??My claim was also rejected on similar grounds

Royal sundaram is also extremely bad on contactability.
Even I have taken an insurance. Its been renewed twice without my knowledge. few days ago a person from the company called and explained a product for which i said not interested and asked to hang up the phone and i was shocked to see a premium is debited from my SBI Card.
Royal Sundaram and SBI Cards has agreement and collectively cheating innocent people. They should be suied.
Dear Friend,

It is good that you shared your experience at this web site. Not only Royal Sundaram, but several other Health Insurance providers in India are arbitrarily rejecting genuine health treatment claims citing reasons of pre-existing diseases. If the Policy has been renewed for 3 or 4 years, no Insurance Company can claim that the disease was pre-existing and was there at the time of taking the policy. Not even Medical science can say clearly when exactly a disease starts in a person before its mainfestation and symptoms.

In case of disputes regarding claims, an insurer can always approach the Insurance Ombudsman with his claim details and the letters received from the insurer rejecting the claim. You can lodge a written complaint with the Insurance Ombudsman of your area. You will get details of the Insurance Ombudsman at IRDA website-

The Insurance Ombudsman is an independent arbitrator who can decide on disputes like this one. Generally their award cannot be questioned by Insurance Company.
So lodge your complaint to the Insurance Ombudsman with all required information. It's free, there is no fee nor is there any need for the service of a lawyer, you can do it yourself. You can even claim damages for the mental agony and financial loss suffered by you due the rejection of cashless facility on flimsy grounds.


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    Vishranthi Melaram Towers, No.2/319, Rajiv Gandhi Salai (OMR), Karapakkam, -, Chennai, Tamil Nadu, India - 600097
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