HDFC Ergo General Insurance — Claim Denied and Pathetic Customer Service

I have had a pathetic experience with this Company.
My mother was admitted for the ailment called "Urinary Tract Infection" or UTI and is still being diagnosed for the same. The denial was based on the USG test report stating "Uterine fibroid and was managed surgically with hysterectomy" for which she was neither admitted nor is being currently diagnosed.

I think these guys are sitting there just to reject and deny claims by giving unfair reasons and then forcing the customer to run behind them, sending them documents in emails for reimbursements to which they do not even reply.

I sent the following mail on 3rd February 2023 to which I haven't received any reply as of now. They don't even have mere professionalism to answer queries of their customers.

Patient Name : Saroj Sharma

HDFC ERGO ID : [protected]
CCN No : RC-HS[protected]
Hospital Name : THE CALCUTTA MEDICAL RESEARCH INSTITUTE
Hospitalization Period : From 01/02/2023 to 10/02/2023
My Mother, Saroj Sharma was admitted to Calcutta Medical Research Institute on 1st Feb 2023 and I applied for a cashless claim which was denied on 2nd Feb 2023. She was admitted for an ailment called "Urinary Tract Infection" which is very common but even then the claim stands denied.
This denial from your end raises the following questions:-
1. My mother was admitted for the ailment called "Urinary Tract Infection" or UTI and is still being diagnosed for the same. The denial was based on the USG test report stating "Uterine fibroid and was managed surgically with hysterectomy" for which she was neither admitted nor is being currently diagnosed. Is it justifiable to deny the claim based on an uncertain future course of diagnosis which may or may not be availed?
2. If above is Yes, then point out the exact Section Nos. from the policy document where a policy claim can be denied for not the current diagnosis but for a future diagnosis.
3. Is it possible to apply for Reimbursement for the above claim and if yes then how to proceed for the same? At the very least for the period before the diagnosis for "Uterine fibroid and was managed surgically with hysterectomy" has not begun subject to if it ever begins.
4. Your website mentions claim settlement of 97% of claims and this is the 2nd time in the span of 10 months that my claim has been denied. So am I the person who always remains in the 3% of people whose claim gets rejected?

Regards
Rohit Sharma

I received an automated thank you message and NO RESPONSE

Then I sent the following mail on 08.02.2023 after getting no response from them
Hello
The mail said i will get a reply within 2 business days But I have not received any reply.

My claim was rejected for wrong reasons and now your team does not have mere professionalism to reply to Customer’s queries.

Is this the service your customers get?

Pathetic service

I have the discharge summary in which the diagnosis clearly says that my Mother was not treated for Uterine Fibroids but my claim was rejected for the same. The rejection is done on unfair grounds.

This is final reminder. If i do not get a Reply within Friday evening i.e. 10.02.2022 I will lodge a complaint in Consumer forum.
Regards,
Rohit Sharma

I got this response on same date

Dear Mr. Sharma,

Greetings from HDFC ERGO General Insurance.

We acknowledge your email dated 08-February-2023 regarding claim number: RC-HS[protected].

Kindly accept our sincere apologies, for the inconvenience caused to you.

We wish to inform you that we have forwarded your request to the designated team under interaction ID: 65159597. We will update you within 24 hours. Your patience is highly appreciated.
Thanks & Regards,
Deepak Aggarwal
Customer Experience Management Team

After this again NO RESPONSE in next 24 hours.

I like everyone else on this site has been cheated by this fraudulent company.
I never expected this from HDFC brand.