HDFC Bank Ergo General Insurance — Denial health insurance claim

Address:	Mumbai City, Maharashtra, 600088
Website:	www.hdfcergo.com

Hello hdfc ergo,

My father-in-law is holding a hdfc health suraksha policy. Policy was initiated on 14/12/2012. Last month he was admitted in sri ramachandra hospital for bypass surgery. Still he is recovering in icu with ventilator support.

When we send you cashless claim request, you have rejected the same with note "patient is a known case of diabetes mellitus for 20 years before the first inception of the policy (14/12/2012). Insured had not disclosed the ailment while purchasing the policy."

I would like to explain you that, around 15 to 20 years back (1997 to 1999) once he has undergone medical treatment for malaria at local doctor at madurai. When the doctor was tested his blood he came to know that the sugar level in his blood was high and advised to take medicine for few months. After few months, doctor was advised to stop taking medicine because of his blood sugar values are normal. There after he didn't took any medicine for diabetes till may 2013.

Four years back (28/05/2013) he was admitted at avn hospital, madurai for lumbar spondylosis. Dr. Biju was advised to take blood test upon his arrival for treatment. His blood glucose level was bit high (224 mg/dl) so he prescribed to take medicine for the same. Thereafter my father-in-law was taking medicine continuously.

On 24/03/2016, he went to pon malligai hospital, adambakkam, chennai. There also doctor suggested to take medicine for his elevated glucose level. Till 11/02/2017 he took the same medicine.

He was admitted to sri ramachandra hospital, porur, chennai on 11/02/2017 for chest pain. After several tests, doctor identified that he is having blocks in his heart blood vessels. Also they advised to go for open heart surgery (Coronary artery bypass grafting (Cabg). Surgery was done on 20/02/2017. Before surgery one of the doctor in the sri ramachandra hospital was asked about his medical history and he informed all his medical history for past 20 years. There he mentioned that 20 years back he took medicine for high blood sugar for few months.

He took hdfc medical insurance policy on 15/12/2012. From 28/05/2013 he is taking medicine for diabetic as advised by dr. Beju, avn hospital, madurai.

Since last 32 days he was taking treatment in icu. So far the medical treatment charges comes around rs 11, 00, 000 (Rupees eleven lakhs). We don't know when he is going to become normal.

He is illiterate and dont know about pre existing disease. Also he took medicine for high blood glucose level for few months in 1997. There after he didnt take any medicine for diabetic until may 2013. Your representative sold the insurance policy singly getting few signatures and didnt ask about diabetic. Now he is in need of claim amount but you have denied. He is not taking treatment for diabetic. He is admitted for cabg.

Please review the condition of the patient.