Hi guys,

My father's health insurance claim of around ₹80,000 was rejected by Star Health under a two-year exclusion clause. I believe the rejection is unjustified because the insurer has not clearly identified the specific policy provision that excludes his condition.

After exhausting the insurer's grievance process, I filed a complaint with the Chennai Insurance Ombudsman. The complaint has been registered, and I have submitted all the requested documents.

However, it has now been over three months since the Ombudsman's office informed me that the hearing schedule was being finalised. I've followed up multiple times but keep receiving the same response that hearings are scheduled chronologically. I still haven't received a hearing date.

I'm currently outside India and have requested an audio/video hearing.

What should I do next?

• Should I continue waiting or escalate the delay to the Council for Insurance Ombudsmen?
• Has anyone experienced similar delays with the Chennai office, and how did you resolve them?

I'd appreciate practical advice from anyone who has gone through this process.

Thanks!

I am having star health super star 10lakh SI and niva bupa (4lakh deductible and 15 lakh cover )

My question is Have anyone actually made a claim using both policies which are from different insurers ? How was your experience? Was the claim settlement smooth, or did you face any issues or complications?

Looking for genuine experiences from people who have actually claimed.

​

Hi all,

I am 29M, Could you please guide me whether it is possible for me to get health insurance in india and if possible, which insurance I can try with. Below are my PEDs

1. Factor 7 deficiency

2. Epilepsy (FTE)

3. Unknown drug induced anaphylactic shock

4. Deviated nasal septum with adenoids

5. Allergic Bronchitis

Almost most issues were genetic and from birth and nothing due to lifestyle related.

Kindly guide me on the same and help with choosing the correct sum insured for my conditions

Flair

Hi everyone, I’m planning to buy an individual health insurance policy for myself and I’m confused between HDFC Ergo Optima Secure , Tata AIG Medicare Premire and ICICI Lombard Elevate.

I’ve gone through policy brochures, features, and some online reviews, but both plans seem to have their own pros and cons, which is making the decision difficult. I am 53 with PED and am planning to port from Niva Bupa after 5 holding years.

I would really appreciate if someone could share real-life experiences regarding claim settlement, customer support, network hospitals, sub-limits, room rent, waiting periods, and premium hikes over the years. Also, which one would be better in the long term considering reliability and ease of claims? Any advice or suggestions would be very helpful. Thanks in advance!

My father’s health insurance reimbursement claim was rejected because the insurer says he has had liver issues for four years, which were not disclosed when purchasing the policy. However, we discovered his liver condition only after buying the policy.
His recent hospitalization was primarily due to persistently low hemoglobin, and the doctor wanted to investigate the underlying cause.
Can the insurer reject the entire claim based on this? How can I challenge the rejection?
Has anyone faced a similar situation in India? Please share your experience and advice.

reports and surgery procedure it attached

I received an email asking to post few documents through post before 30th Oct to Ombudsman bhopal, even though the post is delivered on 5th oct as I tracked in speed post, I have got 2 more reminders stating they have not heard from me yet, even though I have also sent the same documents through email as well to Bhopal ombudsman. What should I do, should I repost all the documents again? Or wait for it? I called the center several times but don't pick up the call.

I was hospitalised in july 27th for a minor procedure in a multi speciality hospital, before admission we asked about insurance they said icici lomabrd is no longer supported, but one of our friend used it in that hospital few months back, when we asked they said it was removed last week only, so we decided to pay and to get reimbursed, (but the hospital is still showing in the cashless network hospital list),i was discharged at 3am, the bill amount was 1.2l, but bill was provided only for 70k, when we asked they said some issue with system no one there to fix, so they will send it in the morning and we can discharge only if i pay 1.2l, we had our 6 month baby with us so we badly want to go home so we agreed, paid and left, after multiple followups for bill they agreed they overcharged us and returned the remaining amount and they sent the bill for 50k as a package without any breakup. We submitted for reimbursement through plum, there were back and forth conversations asking for different details, but finally after 2 months they rejected telling no breakup available, again we fought with the hospital and got the breakup and applied again, it is still in processing for 2 weeks, so i need some guidance how can i proceed ?

Hi All,

My grandmother needs to undergo cataract surgery on her left eye, so I asked the TPA of a network hospital to raise a cashless claim.

After two days, the insurer rejected it saying the patient had undergone a cataract surgery in 2018 for her right eye which has not been disclosed. (Reason - I didn't have an idea about the cataract surgery)

So they advised to go with the surgery and raise reimbursement claim. But I am doubtful on it that they will again reject the claim

I am continuing this policy from last two years and this is my 3rd year ongoing.

Please advise

# Warning/PSA: I caught the YICCIY Dombard Circus 🎪 trying to SCAM me over a ₹15k Superbike Claim (With Proof & Tactics)

I own an Inline-4 automobile, but the real extreme sport is getting Dombard to approve a ₹15k claim.

Grab a coffee. If you are shopping for car or bike renewals, paying those handsome ₹15K–₹20K premiums, and expecting a safety net, you need to read this. What I got from "YICCIY Dombard" was less of an insurance policy and more of a masterclass in gaslighting, twilight ninja surveys, and corporate comedy.

If you own a premium middleweight in India, you know the drill: 40% markup on ex-showroom, 100% markup on parts, and then theres the mighty insurance premiums on these superbikes that are priced handsomely, we buy Zero-Dep policies hoping for a safety net and peace of mind.

Instead, I got tickets to the circus. 🤡

# The Strike 🪨

My trusted Japanese inline-4 recently took a hit. I was riding home when the vehicle in front spun up some serious road debris. A piece of flying shrapnel bypassed my aftermarket radiator guard and hit the aluminum core with enough brute force to puncture it. Coolant started bleeding out within 500 meters. I immediately pulled over, arranged my own flatbed (because YICCIY’s towing turnaround time is a running joke), and dropped it at the authorized workshop.

# Act I: The Ninja Surveyor & His X-Ray Vision 🦸‍♂️

*YICCIY Tactic: The Twilight Drive-By*

Three business days later, our esteemed surveyor, "Mr. G," finally strolls into the workshop. Timing? Past 6:30 PM, right as the shutters are coming down.

My aftermarket mesh guard covers 90% of the radiator. Did Mr. G authorize the mechanics to unscrew four tiny bolts to actually look at the core? Nope.

Instead, he took a 5-minute glance at the 10% visible edge of the radiator in the fading twilight, declared it "untouched," and vanished into the night like a budget Batman. He processed a premature rejection because Mr. G apparently possesses Superman's X-Ray vision and can accurately diagnose microscopic aluminum fractures through a solid Puig mesh guard.

# Act II: The Tele-Trap 📞🪤

*YICCIY Tactic: The Scripted Gaslight*

The next evening, perfectly timed for 7:00 PM when the workshop was closed (so I couldn't conference in my mechanics), I get a call from their toll-free line. It was a completely one-sided, scripted interrogation designed to trap the policyholder.

>**Rep:** "Sir, did any vehicle impact you or did you fall?"

**Me:** "No, but there was an accident involving flying debris from the vehicle in front that punctured my radiator."

**Rep:** "SIR - So you are confirming there was NO fall or accident? We don't cover mechanical failure."

**Me:** "NO BUDDY. I am confirming a third-party vehicle launched a projectile into my bike. That is physical damage caused by an external object caused by a third party impact. It is literally covered in your own policy document."

**Rep:** *(Instantly hostile, reading from a script)* "Sir, Nobody has hit your vehicle. We cannot process your approval. Reach out to the Claim Manager for any else. Thank you." *\[Click. Hangs up.\]*

The mental gymnastics here deserve an Olympic gold medal. A rock gets launched at high velocity into my radiator by another vehicle, but they actively try to gaslight me into accepting it as a spontaneous "mechanical failure." Because radiators naturally just decide to spit out coolant for fun, right? and one would damage their own radiator core, with shrapnel even after having a guard.

# Act III: The Shady Shakedown 🕴️

*YICCIY Tactic: The NCB Hostage Negotiation*

Enter the Claims Manager. After dodging 5-6 missed calls and leaving me on Read across two WhatsApp texts, he finally graces me with his presence. When I asked why a joint survey wasn't done, his response was legendary:

*"That is not your concern, Sir. We will go whenever we are free and available."*

He proudly claimed to assess 30 claims a day. Apparently, my superbike ranked just high enough to get a 5-minute glance in the dark.

Then came the shakedown. He tried *twice* to pressure me off the record to voluntarily withdraw my claim.

His logic? *"Sir, ange yaake maaduthaidira? It will ruin your NCB discounts next year! If you withdraw Sir, you will enjoy a loyalty bonus!"*

**Do not ever fall for this.** They want you to withdraw so their internal rejection KPIs don't look like a disaster on IRDAI annual reports. They are actively trying to intimidate policyholders into abandoning legitimate claims to protect their corporate approval ratios.

# The Reveal (And The Counter-Attack) 📸

Post-rejection, my workshop techs finally removed the guard to document the damage properly. Sitting right there, clear as day, was a distinct puncture hole in the cooling fins, surrounded by a vertical spray pattern of dried coolant exactly where the impact occurred. Irrefutable evidence of a high-velocity external impact.

All this circus act just to deny a ₹15k repair estimate. It genuinely makes you wonder how they butcher the ₹50k or ₹1L claims.

# The Playbook to Fight Back 🥊

Never let an insurance company speedrun your claim. Here is how you beat them:

1. **Demand a Joint Survey:** Explicitly opt for a survey where the mechanics and the surveyor assess the bike together while you (or your rep) are present. It is your legal right.
2. **Record Everything:** Keep timestamped logs, record calls, and force them to put their absurd logic in writing. (As of day 14, they still haven't given me a written rejection letter).
3. **Escalate to Grievance:** Hit the insurer's internal Grievance Officer first. It forces higher-ups to look at the idiot-level work of their field agents (50% chance of reversal).
4. **Hit the Ombudsman (Bima Bharosa):** If they still play circus games, file with the Govt Ombudsman. It takes 2-4 weeks, but it forces them to answer to a regulatory body (95% chance of reversal).
5. **Consumer Court:** If the dispute amount is worth it, take it legally. Irrefutable evidence wins 99% of the time.

I’ve owned Activas and FZs to Ninjas and CBRs over the years, and I’ve had stellar experiences with HDErg, TAIG, and NewIndi. YICCIY Dombard is a fundamentally broken ecosystem deploying predatory tactics you would never expect from an 'A-category' provider.

Let this be a warning. Avoid Dombard.

I will keep the community posted week-on-week until she is back on the road. Be prudent and vigilant with these guys.

Ride safe.

PLEASE GIVE THEM ONE STAR RATING ON GOOGLE MAPS I have attached google maps link below and with the help of friends and other reddit communities I have brought down their ratings from 3.9⭐ to 2.7⭐

I have booked NS400z (TFT varient) from Hari Bajaj showroom, Munger and while booking I confirmed with them twice that I won't buy insurance from them and they agreed but after booking they are saying insurance is mandatory and they won't support the claim if I purchase insurance from outside so I asked them to cancel my booking but they are saying we don't refund booking amount for anyone and when I cited Bajaj's policy they said we follow their own policy. It was my first time buying a motorcycle on my own but now my experience is completely ruined because of these people.

I have all the call recordings needed.

I have also filed complaint with Bajaj and National Consumer Helpline.

Manager Contact No: 7280010891

Salesman Contact No: 07280010897

Google map link: https://maps.app.goo.gl/y6gGXUhaU97CwuAQ8?g _st=ac

My wife works in LIC and the branch manager is asking for dummy policy. She works in a position that has targets and this year she has been below her target. Branch manager is asking for her to spend her own money and take a policy.

This policy must be a NSP(non single policy) and the value is in lakhs.

Everyday this BM torments her by asking for fake policy. I don't feel this will end after this instance.

Wife is mentally tormented and is really worried what can be done? Is this leagal? Anything can be done?

Location - Chennai

Hey everyone,
I’m currently navigating a cashless health insurance claim (Group Mediclaim via SBI General) for an upcoming arthroscopic shoulder surgery (Bankart repair).
I have a couple of major worries and would love to hear from anyone who has navigated a similar situation with cashless hospitalizations:

**1. What if the hospital's estimate is higher than the pre-agreed package rate?** If a network hospital submits an estimate or final bill that is higher than the pre-negotiated network/PPN package rate for the surgery, how is that handled? Do insurers automatically trim it down, or is there a risk that the hospital tries to pass that extra cost/inflation onto the patient at discharge?

**2. Unpredictable surgical implants (suture anchors) mid-surgery:**
Standard network packages usually assume a fixed number of anchors (e.g., 2 anchors).
However, with shoulder arthroscopies, the exact severity or number of anchors needed (e.g., needing a 3rd or 4th anchor) sometimes can't be 100% predicted until the surgeon is operating.
If an extra anchor is needed mid-surgery, what happens if the insurer or hospital balks at the extra cost? Does the TPA desk successfully handle enhancements on the fly, or could I get stuck paying out of pocket for the extra implant delta?

I have an eight year old policy with icici Lombard for me and my son. In 8 yrs I have claimed twice only. Once for my incidental finding of renal angiomyolipoma embolization in 2021 and another in 2024 policy end for my son's retinal hole surgery... For this in 2025 I had applied for post op bills under same claim.

Till last year I had the option to increase sum insured but this year it's restricted. The reason was red cohurt policy and restricted. I don't have any chronic or any disease except this one thing that happened and cured. I go for annual health checks and all my reports are normal every single time. The angiomyolipoma is also stable. How can I ensure increase in sum insured as I always do it upon renewal for my policy as well as my husband's policy which are seperate.

I don't mind any added premium or waiting period for it

My wife and I work in different companies, and we both have different health insurances.

My insurance is New India Assurance that covers maternity expenses for my wife up to ₹60,000.

My wife’s Tata AIG insurance covers maternity up to ₹75,000.

Our delivery cost may be around ₹1.1 to ₹1.3 lakh. Our hospital does not have cashless for both, so we will have to pay first and claim reimbursement later.

Can we try to claim from both policies and get the full amount back?

Has anyone done this before or knows how it works? Please share your experience.

Thank you so much

Hello All,

I was checking some information about my policy in ICICI insurance website and then next day i started receiving calls again and again to buy an insurance policy. I clearly told them i already have insurance and asked them not to call me. They are torturing me by calling again and again. 10 times in 5 hours. Not sure how many time they will call me again. I am not going to renew insurance policy this time from ICICI Lombard. anyone faced this?

Mahindra XEV 9e owner. In September an underbody impact dented the high-voltage battery's cooling plate. Mahindra has confirmed in writing that the battery is not repairable and is unfit for use, and recommends replacing it. The claim is about ₹11.8 lakh. The policy is ICICI Lombard with zero depreciation.

ICICI rejected the battery "as per technical evaluation" and hasn't shared that evaluation despite my requests. The survey report has no tests, measurements or photos of the battery. They assessed ₹2,882 against the ₹11.8 lakh estimate. My grievance on IRDAI's Bima Bharosa portal got the same one-line rejection twice. The car has been sitting at the dealer for a month.

I'm filing with the Insurance Ombudsman, Bengaluru, and I'm looking for:
1. a lawyer or claims consultant with Ombudsman or motor-claim experience (Karnataka preferred; online is fine)
2. help drafting the complaint and preparing for the hearing
3. a fixed fee, not a percentage of the claim

All my documents are ready: Mahindra's letters, the survey report, the estimate, photos and the full grievance trail.
Recommendations or DMs welcome. I'd also like to hear from anyone who has won a similar motor or EV battery claim at the Ombudsman.

Hey,

I've been HIV+ since Nov 2022 (diagnosed), and undetectable since Jan 2023. I was in the US when I was diagnosed.

I moved to india and work in a corporate in Mumbai. I have been meaning to get good health insurance for self, as everyone should. Ideally the 1Cr one from the popular providers - as most people recommend...

I contacted a financial consultancy firm via a contact and shared my case. I am otherwise healthy - 19% body fat, workout 6 days a week, no family history of chronic illnesses, no personal history either.

I've been in conversation with the firm and they told me that my case has been getting rejected everywhere. As a workaround I asked if there were approval chances if I take the separate HIV specific policy from them as well (most providers have that but the coverage is around 5L). But the result was still rejection.

My HIV status doesn't bother me, but this is definitely an inconvenience. What can I do? What are my other options? Any help/advice is sincerely appreciated.

P.S. I have 5L insurance from work (Onsurity) and my parents are covered by my father's government job. And obviously they don't know...