Reliance General Insurance — Complaint Against Reliance General Insurance for Unjust Claim Rejection

Reliance General Insurance — Complaint Against Reliance General Insurance for Unjust Claim Rejection

H Hariomdutt from Gurgaon, Haryana Apr 11, 2025 Apr 11, 2025 This thread was updated on Apr 11, 2025

Dear RGICL Team, Thank you for your response regarding my health insurance claim (Claim No.[protected] under Policy No.[protected]. However, I am disappointed to learn that the claim continues to be denied on the basis of a supposed pre-existing condition. I would like to respectfully reiterate that the treating doctor has clearly certified in the duly filled and signed Part B of the claim form that there was no prior treatment related to the surgery in question. This form has already been submitted as per your requirements and is once again attached here for your review. The mention of an ulcer in the OPD paper dated 26/12/2024 does not, in itself, establish a formal diagnosis or treatment prior to the policy inception. Furthermore, the ulcer was not identified as carcinoma at that stage, nor was any treatment undertaken or advised. As such, the assertion that this constitutes a non-disclosure of a pre-existing condition is neither medically nor procedurally accurate. Given that all formalities have been complied with, and considering the medical certification from the treating doctor, I kindly urge you to reconsider your decision in a fair and objective manner. Should this matter remain unresolved, I will be left with no option but to escalate it to the Insurance Ombudsman as suggested. However, I am hopeful that Reliance General Insurance will re-examine the case in light of the facts and documents provided. Thank you once again for your time and attention. I look forward to your reconsideration and a fair resolution. Warm regards, Hari Om Mobile: [protected] / [protected] Email: [protected]@rediffmail.com Was this information helpful? No (0) Yes (0)
Reliance General Insurance customer support has been notified about the posted complaint. Apr 11, 2025 Updated by Hariomdutt I would like to highlight the following points: No Prior Diagnosis or Treatment: There was no formal diagnosis of carcinoma prior to the policy inception. The ulcer noted in the OPD visit was not identified as cancer, nor was any treatment, investigation, or specialist consultation initiated for it. Medical Declaration by Treating Doctor: As per Part B of the claim form, which was duly filled, signed, and stamped by the senior treating doctor, it is clearly confirmed that there was no prior treatment or related medical history pertaining to the surgery undertaken. This form has been submitted to the insurer as required. Unfounded Basis for Rejection: The insurer has not provided any concrete medical evidence to support their claim of non-disclosure. A vague reference in an OPD note should not form the basis of denying a genuine claim, especially when no prior treatment or diagnosis was made. Repeated Follow-Ups Ignored: I have attempted to resolve the matter through Reliance General Insurance’s internal grievance redressal system, but their responses have remained rigid and dismissive, without due consideration of the facts and documents submitted.
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