[Resolved]  ICICI Lombard — complaint regarding rejection of mediclaim policy claim by icici lombard (policy number: 4016/x/o/[protected]/00/000)

To,
The Honorable Consumer Complaint

Subject: Complaint Regarding Rejection of Mediclaim Policy Claim by ICICI Lombard (Policy Number: 4016/X/O/[protected]/00/000)

Dear Sir/Madam,

I am writing to bring to your attention a grievance I have with ICICI Lombard General Insurance Company regarding the rejection of my mediclaim for my wife’s hospitalization, despite providing all the required documents. I kindly request your intervention to resolve the issue.

Policy Details:

Policy Number: 4016/X/O/[protected]/00/000
Claim Number:[protected]
Claimant: BEENA
Date of Admission: 27th September 2024
Coverage Period: 02-AUG-24 to 01-AUG-25
On the date mentioned, my wife was admitted to the hospital due to a health issue, for which I incurred a medical expenditure of Rs. 71, 000. I promptly filed a claim with ICICI Lombard to recover the expenses, but unfortunately, my claim has been repeatedly rejected by the company.

They initially rejected my claim citing missing documents, and I ensured to provide all required documents in a timely manner, as requested by them. Despite this, I was later informed via email that my claim had been rejected for the following reason:

Reason for Rejection (as per their email):

Misrepresentation of material fact
According to ICICI Lombard, they observed discrepancies in the hospitalization details and have concluded that there was a misrepresentation of facts. As a result, the claim has been rejected under the assumption that false statements were made in the process of obtaining benefits.
However, I firmly believe that no misrepresentation or fraudulent activity took place during the submission of the documents. All the information provided was accurate, and I complied with every request made by ICICI Lombard. It is distressing to see the rejection based on these grounds, especially when I have been transparent throughout the process.

Request for Resolution:
I request the honorable Consumer Court to investigate the matter and provide assistance in resolving the claim rejection. I kindly ask for ICICI Lombard to reconsider the claim and settle it in accordance with the terms of the policy, as I have adhered to all the necessary procedures.

Please find the attached documentation related to my claim for your reference. I would appreciate it if you could help facilitate a fair and just resolution to this matter.

Thank you for your time and attention to this complaint. I look forward to your response and hope for a swift resolution.

Yours sincerely,
Rinku Verma
Veena
[Policy Number: 4016/X/O/[protected]/00/000]
[Claim Number:[protected]]