Hdfc Ergo General Insurance — health claim rejected stating that my father's hospitalization information was fraudulent

 
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 kbkary on Jan 3, 2018
My father was hospitalized on 20th october 2017. He was discharged on 26th october 2017. It was an emergency case so we took him to the nearest hospital available. This hospital is a non-network hospital.
So, i applied for the claim to the company by providing:
1) original bills with hospital stamp and doctor signature.
2) all test reports in original with hospital stamp and doctor signature.
3) all the medicine bills in original with hospital stamp and doctor signature.

After that they keep on sending the queries continuously for 1 month. We fulfilled all their queries related to:
My father's work proof
My father's id proof
Medical certificate from the doctor
Certificate for the medical investigation etc.

For fulfilling all these queries we had to go to hospital several times which made hospital staff upset and unresponsive. Still, we requested doctor, hospital staff and pathologist to support us as we were very hopeful that claim will be approved.
They did their own self investigation by visiting the hospital and getting all the information regarding the patient.

But after 1 and a half month of trouble and mistreatment, company has rejected the claim citing the reason
"as per the documents submitted, the claim was found to be misrepresented. As per the policy terms and conditions, if any claim is in any
Manner dishonest or fraudulent, or is supported by any dishonest or fraudulent means or devices, whether by insured person or anyone acting
On behalf of an insured person, then this policy shall be void and all benefits paid under it shall be forfeited."

So, what i get from here is that they are claiming that all the original documents are fraudulent and hospital staff is lying. Even the doctors claim is untrue.

What was the point of paying premium to this company if in our time of need they are going to label us as a fraud.

I want to lodge a complaint against this company with a hope that you will help us out and get our claim approved.

Complaint Status


[Jan 03, 2018] HDFC ERGO General Insurance customer support has been notified about the posted complaint.
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    Hdfc Ergo General Insurance - health claim rejected stating that my father's hospitalization information was fraudulent