[Resolved] Icici Lombard Health Insurance — Rejection of claim for irrelevant reason
Chennai, Tamil Nadu, India
Hello, Am vijay kumar. I would like to inform everyone that we have been cheated literally by ICICI LOMBARD health insurance company when I claimed for my mother's surgery. Policy details : Name : N.KOWSALYA Policy No: 4128i/HSPR/81690245/02/000 Age : 50 Policy commenced : july 2010 AL number :[protected] for which claim got rejected My mother was suffering from severe stomach ache and so when consulted the doctor he said that it is INCISIONAL HERNIA and she has to undergo surgery for that. When we claimed for cashless hospitalisation through the hospital(APOLLO SPECIALITY HOSPITAL), the insurance company rejected our claim saying that my mother is suffering from diabetes and that has is not there in their database. My father got this policy in 2008 for him and added my mother with that policy by 2010 and they said us that after 4 years all the pre existing diseases will be covered but now even after 5 years also they are rejecting my mother's claim saying that it's not mentioned during the commencement of the policy that she is having diabetes. I informed the doctor regarding this he said they cannot reject the claim since diabetes is no where connected with INCISIONAL HERNIA. When I contacted with customer care representative he told me that they cannot give insurance and told me the same reason. But we are sure that we have said the pre existing diseases during policy commencement but they are refusing it that in their database nothing has been entered. So I asked him what's the proof that we have not said the pre existing diseases and they don't have the answer for that, I informed him what doctor has told us that diabetes is no where connected with incisional hernia and so they asked me to get a letter from doctor and asked me to send the letter to them. So doctor gave us a letter saying that incisional hernia is not because of diabetes but after sending that letter also again they rejected our claim saying the same reason which doctor and hospital itself was not satisfied. Now we don't know what to do and how to arrange such a huge money(2.2 lakhs) and my mom is literally crying every night because of pain which we cannot able to see and tolerate. Pls somebody suggest us what to do and how to proceed further. My kind advice to everyone that pls never ever get a health insurance policy from ICICI LOMBARD they are cheaters and they have no mercy on public they just want to grab the money from us and in return they give only sorrow to us. I have attached the rejection letter from the ICICI LOMBARD and also the doctor letter
Complaint marked as Resolved
First i thank INDIAN CONSUMER COMPLAIN FORUM and secondly thanks to icici lombard insurance company for resolving my complaint. Our cashless hospitalization which was rejected has been approved now, thanks to Nikita Tripathi, service quality team, icici lombard insurance.The email address from which i got the reply is [email protected]
[Sep 05, 2015] ICICI Lombard customer support has been notified about the posted complaint.
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