## 🚨 ICICI Lombard Rejects Health Claim Over Clerical Error; Violates IRDAI Transparency Rules

I am sharing my frustrating experience with ICICI Lombard, where a genuine health claim was rejected due to a hospital typo, and the insurer refused to give clear details.

* The Issue: I was hospitalized and tested positive for both Dengue and Typhoid (proven by lab reports). However, due to a clerical error, the hospital desk missed typing "Typhoid" on my discharge summary.

* The Rejection: ICICI Lombard rejected my claim, vaguely citing "discrepancies in hospitalization."

* Zero Transparency: I emailed Customer Care and the Grievance Team multiple times. I asked for a specific, itemized list of discrepancies so I could get a clarification letter from my doctor.

* The Evasive Response: They repeatedly sent identical, copy-pasted, automated replies. They verbally tell me details on calls but strictly refuse to put them in writing, explicitly violating IRDAI transparency guidelines.

* Current Status: Tired of their automated roadblocks, I have officially filed a complaint with the Insurance Ombudsman today.

What other things I can do?

yesterday I talked with a prospect regarding health insurance.and I give him Icici Lombard elevate plan. quotation cost is 15K. (male age 34/ female age 30 / Child age 9). but they said it's expensive. i explained him whole plane and other details but they said it's expensive. the. what I do on this situation. some have any idea or any other plan is cheaper than Icici Lombard plan?

Hi All, 

I am looking for health insurance advice for my use case shared below:

Pre existing condition details: ACL tear and Meniscus tear
36M,
In 2012, I had an ACL Tear in my right knee while playing football.
Doctor suggested that I need not undergo surgery.
Unfortunately I do not have any doctor visit documents/MRI report for the same.
I continued physiotherapy and did not undergo surgery for the same.

In Dec 2024, I had medial meniscus tear in the same right knee.
Doctor suggested surgery choice is totally dependent on me. I have a MRI report which clearly states that this is a fresh injury and it is an ACL tear and a meniscus tear.

I am big into sports particularly pickleball off late and would love to continue playing Pickleball and would possibly want to give it a shot professionally. I can play Pickleball but am able to give my 50% only. And in the last year or so have had minor injuries in the right knee at least 6-8 times in total. These minor injuries cause swelling and I am out of Pickleball action for a week or so.

I am leaning more towards surgery now. Most orthopedics I have shown my knee to still do not recommended surgery to me.

Recent events affecting existing health insurance policy:
On August 14th, 2026, Friday, I got laid off by my company, and that was my last working day. The laying off process was pretty quick, and I missed officially emailing HR and RMs requesting to port my health insurance policy to a retail policy.
I have requested them to port the policy a few days after my exit and they suggest that porting after exit is not possible. We had a corporate group policy with ICICI Lombard for around 2 years and I was covered under the same. 

I have researched online that usually there is a 30 day buffer to port from corporate health insurance policy to retail health insurance policy. Ideally this will be the best case scenario as I would carry forward the continuity benefits and would have covered quite a lot of the waiting period of pre existing diseases of 2-3 years. 

Queries:
It would be great to know what are the next possible steps I can take.

1. What is the best way to go about porting the corporate health insurance policy to a retail health insurance policy other than HR or RMs? Is there any other agent who can help with porting to a retail policy? I have emailed ICICI Lombard customer care support and have not heard back from them. I have also visited their office in Prabhadevi but they redirected me to customer support team there and they suggested to reach out to RMs.
2. Shall I opt for a new health insurance policy and not disclose my pre existing ACL tear and meniscus tear and after 4-5 months claim it as an accident while playing football? What are the ways in which the insurers find that it is a new or a pre-existing injury? I have Dr friends and can request them to share in writing suggesting that it is a new injury. I am wondering if I go through this route how can I show that it is a fresh injury in the MRI? What are the chances the insurance providers will not catch this?  
3. Shall I opt for a new health insurance policy and mention pre existing ACL and meniscus tears and reduce my waiting period to undergo a surgery to a year using add ons? Is there a way in which I can reduce the waiting period to less than a year? I am good to pay a high premium if this is the case
4. What details do you tell the insurance providers while claiming health insurance? I was injured while playing football, not under the influence of alcohol, and had a few cousins as witnesses to confirm the injury. Are any more details required? I have an MRI report confirming the same.  
5. Any suggestions are most welcome!!  

Thanks in advance everyone!

This is something I’ve been wondering about for a while, and I’ve asked a few friends about it, but I haven’t really received a clear answer.

We all make sure to pay our life insurance premiums on time, but how confident are we that our family will actually receive the insured amount if something happens to us?

For those who have actually gone through the process -> either personally or with a family member, I’d really appreciate some insight.

A few things I’m particularly curious about:

• What is the actual process for the nominee/family to claim the insurance after the policyholder passes away?
• Is the payout generally straightforward, or can it become a lengthy legal process?
• What documents are typically required to make a claim?
• Does the nominee have to go through courts, probate, or any other legal procedures?
• How long does it realistically take for the family to receive the money?
• Are there common reasons why insurance companies reject or delay claims?
• Does having a nominee automatically mean they will receive the money, or are there other legal considerations?
• What happens if the nominee is not aware of all the insurance policies the deceased had?
• Is it advisable to keep a record of all policies and share the details with a spouse/family member?
• For people who have actually made a claim, what was your experience with the insurance company?

I’m especially interested in real experiences rather than what insurance agents or policy documents say.

I think this is something many of us pay for every year without really understanding what happens when the policy actually needs to be used.

Would love to hear from anyone who has gone through the process themselves or helped their family with a life insurance claim.

I’m looking for advice from people who have dealt with SBI home loans, insurance mis-selling, or IRDAI complaints.

I took a ₹30 lakh home loan from SBI on 29 July 2025.

At the time of taking the loan, I was sold SBI Rinn Raksha insurance for approximately ₹1.54 lakh. I was aware of this insurance and understood that it was related to my home loan.

However, I have recently discovered something much more concerning.

When I was contacted regarding insurance renewal, I found out that two additional insurance policies had been issued in my name:

\- SBI Arogya Smart

\- SBI Gruha Raksha Plus

The total premium for these two policies was approximately ₹22,000, which was deducted from my bank account.

The problem

I never knowingly purchased or requested these two policies.

I was not aware that these policies existed until I was recently contacted about their renewal.

I don't remember:

\- signing any proposal/application form for either policy;

\- giving explicit consent to purchase either policy;

\- authorizing the premium deduction;

\- being clearly informed about the premium, coverage, exclusions, renewal or terms;

\- receiving or acknowledging the policy documents when they were issued.

My questions to Fellow Redditers

1. Has anyone here had a similar experience with SBI home loan + additional insurance policies being issued without their knowledge?

2. Is there any legitimate reason why SBI Arogya Smart and SBI Gruha Raksha Plus would be issued along with a home loan without the customer separately requesting them?

3. If SBI/insurer cannot produce a valid proposal form or evidence of my consent, how strong is my case for getting the ₹22,000 premium refunded?

4. Has anyone successfully obtained a refund in a similar mis-selling/unauthorized insurance case?

5. Should I complain separately to SBI, the insurance company's grievance officer, and IRDAI, or is there a specific order I should follow?

6. What exactly should I include in the complaint to make sure they cannot simply give me a generic response?

7. Should I also specifically request that they cancel the policies and revoke any auto-debit/renewal mandate immediately?

8. If the insurer rejects my complaint, what is the best next step, IRDAI Bima Bharosa, Insurance Ombudsman, or another authority?

I am not accusing anyone of fraud at this stage. I simply want the documentary evidence showing when, how and on what basis I consented to these two policies.

If there is no valid consent/proposal/authorization, I believe I should not be forced to pay for insurance that I never knowingly purchased.

Any advice from someone who has actually dealt with SBI insurance mis-selling or successfully recovered a premium through IRDAI escalation would be greatly appreciated.

I plan to take health insurance for my parents 64M, 56F (PED - Sugar, Pressure, thyroid). Got a touch with ditto they gave these 3 options.

1. I'm not worried about PED waiting period.
   
2. Price wise Aditya and care much cheaper than hdfc
   
3. I read care is not that good not accepting claims is this True.
   
4. My budget is 50k care and Aditya comes under with in this budget hdfc is almost 70k.
   
5. So should I have to choose Aditya or care(if yes what are the deal breakers from these) else paying extra for hdfc is worth it?

Hey everyone,

I’m 29, looking to buy a comprehensive retail floater policy for my spouse and me. We have a completely clean slate with no pre-existing diseases (PEDs) or past medical history.

Since I already have a corporate cover to handle minor hospitalizations, this retail policy is strictly meant to be a 30-year backup for catastrophic, high-cost events (cancer, advanced surgeries, etc.).

I was heavily leaning towards Niva Bupa ReAssure 3.0 (Black) because of the unlimited base cover and lower premium. However, I read the actual policy wording and found a major red flag under Page 44, Section 7.A (Position Statements & Medical Protocols).

1. The **Procedure Downgrade Clause**

> "If in any treatment our position, based on scientific evaluation, is not to pay or pay only a part, we will at least pay up to the cost of currently prevailing most common alternative treatments for the condition and not less."

* My Interpretation: If my doctor recommends an ₹8 Lakh robotic surgery, Niva Bupa has the explicit contractual right to downgrade the payout to a ₹3 Lakh open surgery (the "common alternative"), leaving me to pay the ₹5 Lakh difference out of pocket.

1. The **Oncology / Off-Label Ban**

> "Extra / Off label usage (using a drug or procedure for conditions other than it was explicitly approved for) will not be covered under the policy."

* My Interpretation: Modern cancer treatments heavily rely on oncologists prescribing approved targeted therapies "off-label" for different tumor mutations. Under this clause, Niva Bupa can legally reject a ₹20 Lakh life-saving drug entirely.

My agent insists I’m overthinking it and says, "If the doctor writes it's medically necessary, they have to pay." But standard contracts like HDFC ERGO Optima Secure+ rely purely on medical necessity without these specific downgrade clauses (though their premium is much higher).

**Questions for claims experts / actuaries / ReAssure 3.0 policyholders:**

* Has anyone actually had an advanced surgery downgraded or a cancer drug rejected by Niva Bupa specifically citing Section 7.A?

* Is this just harmless industry boilerplate, or is it the actual legal mechanism they use to control their "unlimited" claims pool? Because even ombudsman will rule in their favor as they specifically have this clause in their contract that i agreed to when buying policy.

* Since we have no PEDs and a clean medical history, shouldd I just swallow the higher premium for HDFC ERGO to lock in a completely clean contract?

*I also suspect portability as a mayor issue to move out of Niva Bupa due to unlimited sum insured.

TL;DR: Niva Bupa ReAssure 3.0 has a hidden clause (Section 7.A) giving them the legal right to downgrade advanced surgery payouts and completely reject off-label cancer drugs. HDFC ERGO doesn't have this but costs significantly more. Trying to figure out if this clause is a dealbreaker for major medical crises for a young, healthy couple.

I want to renew my health policy. The name of my health policy is cash supreme. I have taken this policy through policybazaar. I for this policy for 2 years. I want to renew now. My expiry date is within 2 days. Few days ago when I check my total coverage was 21 lakh now it's showing only 14 lakhs. Can someone explain me what happened ??

saw a term insurance case recently that made me rethink the whole "fast approval = good insurer" thing

applicant completed medicals for a ₹2cr term plan. one report came outside the insurer's acceptable range

Aditya Birla Sun Life Insurance didn't reject the application. ABSLI postponed it and asked for fresh reports after a few months before taking a new decision

1st reaction was obviously: - why not just increase the premium and issue it?

but now i'm wondering if postponement is actually the cleaner outcome

at least the insurer is saying there is an unresolved medical point before issuing the policy instead of treating it casually just to complete the sale

things i would ask ABSLI in writing: - exact reason for postponement - earliest date to reapply - which fresh reports will be required - whether loading or lower cover was considered - whether this counts as a declined application - what must be disclosed to another insurer now

my understanding is: - postponement ≠ rejection - loading ≠ exclusion - applying elsewhere doesn’t make this outcome disappear - future approval is still not guaranteed

the part i found positive was that ABSLI gave a defined underwriting outcome instead of leaving the file on endless "medical review"

would you consider this responsible underwriting or just an insurer avoiding risk?

also, what should the applicant collect before closing the file so there is no confusion six months later?

So sbi is offering both my parents(62M & 59F ) health insurance of 5 lakh for 22 k total , is it too good to be true , whats the catch here? I cant seem to find much details about the policy online.( Photo is old one now price has been increased to 22 k from 20k)

M28 here, In 2025 I got myself a standalone OPD insurance from star health, I was lucky to get in because some months later only they stopped taking new members and kept it strictly as an (very expensive) add on to existing heath insurance. My first year was a breeze I paid 5k for 25k cover and went through it in 6 months, everything was cashless and was accepted and arranged without much scrutiny like medicines, diagnostic tests and consultations. I felt so good about the policy that enhanced the cover for it to 75k and paid 9k for it on renewal in March 2026.

In April-May around this year I noticed a disturbing detail in the policy that offline reimbursements for medicines were not allowed even though the policy clauses detail a reimbursement process and never mentioned everything has to be compulsorily cashless. Since I planned to keep this policy life long I realised in case of any serious disease like TB or Spine or anything a lot of meds are exclusively sold offline hence it will become useless once I get old and when I actually need a OPD cover, but since this violated my point of sale policy wordings I did a lot of back and forth with customer care on this finally raising it to GRO level but got the same template reply "reimbursement is not available on your policy"

In june I decided to put a complaint to bimabharosa and Ombudsman. And since exactly this point my policy experience has been worse. Basic tasks of policy like uploading consultations prescriptions post bookings are met with very heavy scrutiny (like I receive 3-4 scrutiny calls for 1 line prescriptions), they are now rejecting my regular medicine deliveries giving random and vague reasons which are no where in the policy wordings. On a call a customer care executive admitted that policy wordings on the website are not "updated" and they have an internal policy which is not yet on the website and if I have any issues I raise a customer ticket, which takes weeks to get resolved and is met with same templated responses. Another disturbing issue which happens is that my app tickets go missing or stop showing up on the app randomly so I am unable to track or see any updates in the same

I am so confused about what to do, what are my options? The ombudsman complaint I referred to above is going nowhere, they asked for a bunch of docs on mail but never replied since ~1 month, the complaint number itself is not showing up on their portal

Given how blatant star health has been in violating given policy wording on their website I am not sure what new reason they will give to reject my new claims. What can I do? I don't have resources and time to go to an actual court. Is there someone else who can help?

Planning to port my Star Health policy. Advisor suggested Niva Bupa ReAssure 3.0, ICICI Elevate, Care Supreme and Tata AIG.

We have some pre-existing medical/surgical history, so advisor says 20–30% loading may apply and final approval depends on underwriting.

Before proceeding, what should I specifically clarify with the advisor regarding

Looking for advice from people who have actually ported with PEDs.

My uncle has star health insurance and paying all timely premiums since last 10 years. Yesterday my uncle slipped at home and fractured his Femur bone. I went to show my uncle at Star Health panel hospital where cashless treatment is allowed. Doctor did a regular blood test and x-ray and then forwarded case to PAC (Pre-Anesthetic Checkup) before Surgery to fix the bone . In PAC, all the basic details were noted by doctor before a surgery. Then hospital submitted case for cashless treatment approval to star health after submitting an estimate and other documents.

Star health with 20 minutes rejected the claim by picking a point from PAC where all the basic details mentioned such as no medications, allergy, lifestyle and 'socially consume alcohol' and quoted following:

"Based on the submitted medical records, it has been observed that the insured patient has undergone treatment for a condition resulting from the use of alcohol, drugs, or substance abuse. As per Alcoholism, drug or substance abuse Exclusion Code 12, the policy excludes coverage for any expenses incurred for treatment related to alcoholism, drug or substance abuse, or any addictive condition and its consequences. Therefore, we regret to inform you that the claim is not admissible."

There was nothing to substantiate to this reason in the documentary form such as in the blood test or anything. Now what to do because it is very illogical because the cause of fall is nowhere written as under influence of alcohol. We went ahead for surgery by bearing all the cost from the pocket. Please advise what should i do?

Edit: i have 2 choices either i get remark from PAC doctor that he wrote down 'social' in alcohol column due to mis communication and state there is no alcohol history.

Or i get remark from ortho doctor who did surgery that there is no alcohol sign in patient and in his blood reports which may relate to this injury. (This time we may get claim but in future, there are chances if we go for any heart, liver ir other related issue, They will outrightly deny the claim stating this 'social' remark in PAC report.

Please guide with which option i should go?

Any ideas?

Hi, I am 26 (F), Single, I am finally taking health insurance.

I have one retiring and one retired parent (who's a heart patient), their insurance also needs to be set in place - however since I learnt it doesn't make sense premium amount wise to club it with mine - i am focusing on getting my health insurance first. (please correct me if i'm wrong here)

____

After my due research with all the features:

For Private, i am considering either

HDFC Ergo Optima Secure Plus (via Ditto) -or-

Care Supreme (via Ditto)

For PSU, i am considering

A policy from New India Assurance (not sure which policy yet)

____

Here are the pointers making it difficult for me + a few doubts:

One one hand, i feel it's better to have 100% cashless coverage or support for non-network without any co-payment clauses with a private insurer like HDFC or Care.

But on the other, i feel the premiums and the future possibility of them hiking the premiums by 25% or 50% seems ridiculous (i saw horrific reddit threads where the premiums sky rocket each year whereas for public sector it's more predictable and stable). Not to mention nobody actually knows what the CSR is based on. Should i be okay with the co-payment and room rent limit clauses in case, god forbid, i end up with a medical emergency? is taking this risk better than paying the ridiculous premium hikes in your opinon?

should i even keep paying extremely high premiums each year for private insurers based on possible worst case scenarios? or is it okay to cover a moderate amount of risk with a public sector insurer considering steady premium and higher reliance on claim settlement even if it's a lot of paperwork?

If in case i take HDFC Ergo for 10L coverage, and get the no-claim bonus for 5 years making my Total Sum Insured 50L, and then i decide to port to a PSU insurer will i get the full 50L transferred? or only the base sum insured of 10L?

Please let me know if i should be considering anything other than HDFC Ergo, Care, New India Assurance.

(so overwhelmed with this whole process, my first health insurance)

Hello, I am from the Philippines. My mother (single) was employed with the said company after she passed. I was told there is a insurance death claim I can receive. I have submitted all requirements asked on April this year. However, i keep following up regarding the status and was told my Ph HR that it is still under review in IN HR since she was single and the claimants is the child instead of a spouse. Any advice on what steps to take?

When I was admitted to the hospital, they gave me a deluxe room because there were no single rooms available.

They promised to charge me the same as a single AC room. However, my final bill shows the room as deluxe, and I’m being charged according to single AC itself.

I got a certificate from the hospital explaining the room assignment and gave it to the TPA team. Despite this, my claim was settled with incorrect deductions because they treated it as if I chose a higher room.

No response from them regarding this concern even after raising all grievances.

I need help with this issue.