[Resolved]  ICICI Lombard — Rejection Of ICICI Lombard Medical Claim

This is in reference to Insurance policy number 4015i/DOPD/[protected]/00/000 and cashless claim no.[protected] rejection.

I want to bring to your notice the way my husband Mr. Dinesh Sharma's insurance case was handled. It is extremely shocking and disappointing to see such a behaviour from ICICI inspite of maintaining very good and trustworthy relationship with the bank.


Below are some key facts, I would like to highlight -
1. My family holds all saving/current accounts in ICICI Bank. Our appointed relationship manager is Mr Raman Mishra from Kirti Nagar Branch, New Delhi.
2. Mr.Raman Mishra has been our contact person from past 4-5 years and recommend us to transfer our existing medical insurance from National Insurance Company (inceptionn year 2014)to ICICI Lombard in 2020. He assured that the policy would cover all health issues and would be cashless with smooth and prompt financial cover with no hassles.
3. At the time of transfer all existing medical ailments and medical history of all members was disclosed. It was clearly mentioned that Mr.Dinesh Sharma has a medical condition of Diabetes.
4. Unfortunately, this was not mentioned in the policy and was a miss from our side as well. The reason of not explicitly checking the terms and conditions was the assumption that this is a transfer case of an existing policy and all terms remain the same. The premium of the new policy also remained the same in this case.

5. Mr. Dinesh Sharma complained of sievere stomach pain on 30.08.2021 and was admitted in BLK Hospital, Pusa Road, New Delhi in emergency.
6. At the time of admission, all pre history of diabetes was disclosed and necessary pre approval from ICICI Lombard was taken. Later a representative from ICICI Lombard was sent who made an estimate of Rs1.90 lac and explained to me that the dietician visit and few small expenses will not be covered in the policy which amounted to around Rs 15, 000 only. I was asked to pay Rs 20, 000 as advance deposit which i paid from my pocket.
7. During this time, I was again in touch with Mr. Raman Mishra who advised me to go for a private room and not sharing one as it will all be covered in the policy.
8. For 5 days in the hospital we were not asked to pay any money and then a person from ICICI Lombard visited us in the hospital and we were asked about the health issue and undergoing treatment. He kept questioning and tried to confuse us and we were shocked to see his perplexed behaviour. He made me write on his papers my husbands health issues, even though he had all his reports in hand. He acted very wierd and very unprofessional.

We were informed the following day that our claim has been rejected by ICICI Lombard and were asked to deposit cash ASAP.
We had no financial arrangement to pay to the hospital.My husband's treatment was stopped and we had to discharge the patient in the absence of funds for the treatment. My family was in a turmoil and had to borrow money to pay the hospital bill inspite of being medically insured by ICICI.

I request you to kindly look into this matter and help with my claim settlement so that I can be reimbursed the hospital expense.

Thanks
VINNI SHARMA
W/O DINESH SHARMA
MOB: +91 [protected]/[protected]