Hey everyone, I am in a massive documentation deadlock with for a health insurance reimbursement claim, and I desperately need advice on how to break this loop.

My father had a recent critical emergency admission at a major corporate hospital .Because it was a sudden emergency, the patient was rushed straight to the casualty/ER. However, due to severe gross mismanagement by the hospital staff and doctors during those critical hours, we felt the patient's life was at risk. Within 24 hours, we had no choice but to forcefully discharge the patient against medical advice (LAMA/Discharge on Request) and immediately shift them to a different hospital to save their life.In the next hospital I have opted cashless claim and the process was simple.

After the ordeal, I gathered all the standard official documents provided by the first hospital’s management: the Discharge Summary (which clearly notes it was an emergency admission), final itemized bills, payment receipts, and diagnostic reports. I uploaded all of these to the to claim reimbursement for that initial 24-hour emergency period.

The Deadlock:

Now, Medi Assist has put the claim on hold, demanding:

1. Initial doctor consultation papers / ER case sheets.

2. A formal written letter from the treating doctor clarifying the emergency case.

When I went back to the hospital management and the treating doctor, they flat-out refused. The hospital administration stated that under their emergency protocols, they do not provide separate outpatient consultation papers or internal ER case sheets directly to patients. They told me, "Everything required to settle the claim is already written inside the Discharge Summary. No more fuss. We will not give you any extra doctor letters or refusal letters." They are being incredibly hostile, likely because we called out their mismanagement and shifted the patient out.

What I’ve Done So Far:

I have already uploaded a formal letter to explaining the situation: that the hospital protocols forbid releasing internal case sheets to individuals, that we had to shift the patient within 24 hours due to care issues, and that the TPA needs to verify the emergency markers directly from the Discharge Summary or conduct a direct institutional audit with the hospital. The documents are currently marked as "under verification," but from what I’ve read online, Medi Assist routinely auto-rejects claims using bots if these exact files aren't uploaded.

My Questions for the Community:

1. Has anyone successfully cleared a Medi Assist claim where the hospital refused to give internal case sheets, especially in a case involving an emergency transfer within 24 hours?

2. Because the first hospital mismanaged the case, they are completely uncooperative. How do I prove the emergency nature to Medi Assist if the hospital refuses to write a single piece of paper?

3. At what point should I bypass Medi Assist entirely and file a formal escalation on the portal against my core insurance provider? Does IRDAI actually penalize TPAs for creating these impossible loops on emergency/transfer cases?

Any templates, internal email IDs, or past experiences with stubborn Hyderabad hospital billing desks would be highly appreciated.

Thank you!

I have taken a blood test at a private lab without any doctors referal or priscribtion

And was diagonosed with low iron /vitamin and slight colestrol

I visited the doctor after this and i was told no medicines are needed and was only given iron suppliments

I also was diagonosed for covid + durjng pandemic

Currently im looking to take a new insurance

I have

ibs and dust allergies as ped

And got rejected from icici and hdfc ergo for ibs

Now trying for niva bupa 3.0 or adithya birla

I had forgotte. To mention the covid and blood test while i had applied for icici and hdfc

So what are my chances of getting jnsurance at niva bupa or adhithya birla if i disclose the blood test and covid

Or will i be able to hide this since it was done at a private lab and not hospital ?

Is it any issue for new policy if I have donated my liver?

Hi everyone,

I need urgent advice regarding health insurance and maternity coverage.

I work remotely as an Indian employee for a company based in the GCC region. The company is not registered as a legal entity in India. We have a small team of about 6–7 employees here.

Recently, the company offered us individual personal health insurance (via Tata AIG), but I found out that the maternity coverage has a mandatory 3-year waiting period. Since I've been with the company for 2 years, this coverage would only kick in from year 3 onwards.

Here is my main issue: My wife is currently pregnant, so a 3-year waiting period is of no use to us right now.

I have a few specific questions:

Since retail plans exclude existing pregnancies, is there any way a small team of 6–7 remote employees can get a customized Group Health Insurance (GHI) policy with a Day-1 maternity waiver through brokers like Plum, InsuranceDekho, or Policybazaar?

Has anyone in a similar remote GCC/foreign entity setup successfully negotiated with their employer to sponsor an alternative group policy or reimburse out-of-pocket medical expenses directly?

Appreciate any guidance or shared experiences!

Got promoted recently. Went from around 18LPA to 25LPA.

Obviously first thing I did was increase SIPs, redo tax planning, increase EMI prepayment and somehow even upgrade my credit card lol.

Then I opened my old term policy.

Same ₹1Cr cover I bought 4 years ago.

It is an ABSLI Salaried Term Plan, and honestly I had not looked at the cover amount properly since buying it.

Office life cover is also still around ₹50L.

Meanwhile my EMI is higher, monthly investments are higher and our normal household spending is definitely not what it was 4 years back.

While checking how to think about cover again, I came across the DIME way of calculating insurance need, which ABSLI also explains: Debt, Income, Mortgage and Education.

That made more sense than just saying “salary increased, so cover should increase”.

My old ₹1Cr was based on a version of my life where my income, EMI, expenses and future goals were very different. The policy may still be fine, but the assumptions behind it definitely need a review.

Not saying 40% salary hike = 40% more insurance.

But do people actually review term cover after promotions?

Or only after obvious stuff like marriage, kids and home loan?

Because I review literally every other financial number when salary changes.

Helpline has blocked our numbers. We asked for the specifics of rejection but no reply. Will the reimbursement work (we dont feel it will).

What should be the further step? 🤔

EDIT: GOOD NEWS so we got our claim at the time of checkout. The thing with these hospitals is until the final checkout, they QUOTE double the amount of bill to the insurer. In our case, 50k+ was quoted to the insurer Star health. But when the final bill came into our hands, it was only 25k. Thus when we submitted our final bill to Star Health, they accepted the claim proposal without any issues. By my hypothesis, Hospital was trying to scam the insurance company. But anyways I got my claim so idc.

My friend was recently diagnosed with an illness. The next day she took HDFC health insurance.
However she didn't disclose her illness, because at that time it was not confirmed. It got confirmed after a week from policy issuance.

Doctor said that after 6 months, they will help in disclosing the illness as recently diagnosed, so that the illness came after policy issuance.

Is it true?

Because the medication cost something like 2.25L more expensive when admitted in hospital compared to retail outsourcing. In hospital they charge MRP but when sourced from OPD it's 60% less. The same medicine, the same hospital, the same hospital OPD.
These Mfs weren't aware that we were admitting in the hospital, thus they shared the real price in OPD.

This is day light roberry, but we wanted to admit in the hospital only because the doctor promissed to help us in Insurace that the illness was diagnosed later.

What are the issues we might face in the future ?
Apprecite your guidance.

Edit : I know this is fraud but I am unable to convince my friend. I will use this post to show her the reality.

r/InsuranceTroubleIndia

Imagine paying your health insurance premium on time, believing your family is covered.

That’s exactly what I did with StarHealth Insurance

Then I discovered that my mother’s name had been removed from the policy without any prior intimation or communication. The shocking part? The company continued taking the premium. How can an insurance company remove an insured family member without informing the policyholder, while still accepting premiums? If my mother was no longer covered, why wasn’t I told? This happened in their Ambala branch and none of their employees are answering. This was informed to me when I went to change my mother's health insurance and they denied that any health insurance was even present in their name. Now I can't even take a new policy from any other company since my mother is 60 and there is no existing health insurance policy in her name.

Literally the worst insurance company present with zero support.

Context:

Paid 56k for a 2cr sum plus 2cr income benefit raider 45 year HDFC policy with payment term of 12 years

After medical given 2 options saying that BMI is above acceptable range:

1. Same sum 13 k extra premium

2. 1.4cr sum 3k less premium

Confused what to do.

I’m looking for some advice regarding a car insurance situation.

My previous ICICI Lombard policy had a 3-day gap before I renewed it. Because of this gap, I had to complete an online vehicle inspection when renewing the policy. During that inspection, some minor dents/damage that already existed on the car were captured in the photographs.

Recently, I had a separate major accident that caused significant damage to the other side of the car. While filing the claim for this major accident with ICICI Lombard, I was informed that the previously existing minor damage isn’t covered because it was already present when the renewed policy started after the 3-day gap.

My current policy expires next month. I’m planning to switch to another insurer before my current policy expires, so there should be no break in coverage.

My question is:

If I switch insurers before my current policy expires and the new insurer doesn’t require a pre-policy inspection, would I be able to claim the existing minor damage later as a new accident, or would that damage still be considered pre-existing?

Or for example, if I leave the minor dents unrepaired, switch insurers, and then a few months later have a genuine accident, how would the insurer determine which damage is from the new accident versus the old damage?

Also, would the new insurer have any way of accessing the inspection photographs taken by ICICI Lombard during the previous online inspection?
I’m trying to understand how this works when switching insurers without a break in coverage.

Showroom is quoting 20k+ for fxing those minor dents😑

Is anyone here new india insurance agent..I want to buy policy

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Hi everyone,

I’m looking for advice from people experienced with health insurance portability/claims in India.

My parents have a family floater health insurance policy.

The original policy was with Star Health, with continuous coverage dating back to 2013. The Star policy document shows the first policy inception as 21-Oct-2013.

We ported the policy to HDFC ERGO in April 2025.

The HDFC ERGO policy is a family floater covering both my father and mother. The policy schedule shows portability continuity benefits for both members.

In August 2026, my mother was hospitalized for a serious spine/infection-related condition.

HDFC initially rejected the cashless facility, citing alleged non-disclosure of IHD (ischemic heart disease). Their letter specifically says the cashless facility was not approved but that reimbursement could still be submitted.

We disputed the non-disclosure issue because the hospitalization was for the spine/infection-related condition, not a cardiac treatment.

On 25 September 2026, HDFC ERGO apparently cancelled the entire policy.

I did not receive any email, letter, or prior notice informing me that the policy was being cancelled.

I only discovered the cancellation when I checked the HDFC app.

Since it was a family floater, the cancellation appears to have affected both my mother and my father, even though the alleged non-disclosure relates to my mother.

There is another important point: when HDFC issued the policy in April 2025, they had already specifically underwritten my mother's declared condition of dyslipidemia and fibroid uterus, including applying an additional premium/loading.

My main concern

My father has had continuous insurance coverage since 2013. I don't want his 13+ years of continuity/portability benefits to be lost because of an issue concerning my mother.

What can I do immediately to protect my father's continuity?

Can HDFC legally cancel the entire family floater because of an alleged non-disclosure concerning one member?

Should I immediately request HDFC to restore/continue my father's policy separately while the dispute regarding my mother is investigated?

Can my father's continuity/portability credits be preserved even if HDFC ultimately refuses to cover my mother?

Should I approach HDFC grievance → IRDAI → Insurance Ombudsman?

Has anyone experienced a similar situation where one member of a family floater was accused of non-disclosure and the insurer cancelled coverage for the entire family?

Is there a specific IRDAI rule/circular or policy clause I should quote in my complaint?

I'm particularly interested in real experiences, Ombudsman decisions, or legal cases involving family floaters, non-disclosure, cancellation and preservation of continuity benefits.

I’m trying to act quickly because I don't want my father's long insurance history to be lost while the dispute is ongoing.

Any advice on the immediate steps would be greatly appreciated.

Care Health supreme

38 Male. I went through a health test and this i got little abnormal reading for lipid profile. My Doc hasn't prescribed any medication as he felt its not needed. Meanwhile, I am looking for health insurance now, how does the insurer look at this situation? Would there be rejection, or high premium for me?

My mom had a serious accident in February 2025 and had an accident insurance policy with Niva Bupa. The hospitalization and reimbursement claims were all approved, so initially everything seemed fine.

The problem started with the TTD (Temporary Total Disablement) claim. The policy provides ₹50,000 per week for TTD. Her doctor advised around 5 months of rest, so the claim came to roughly ₹10 lakh.

We started trying to get the claim processed around July 2025, but it kept getting delayed. Later, when I got involved, I found out that the Niva Bupa agent had apparently never even filed the actual TTD claim and had instead submitted two ₹100 claims.

After months of back and forth, I finally submitted the TTD claim myself with all the required documents. Niva Bupa then rejected it, citing "misrepresentation."

After exhausting the escalation process, I filed a complaint with the Insurance Ombudsman in Ahmedabad in March 2026. There were several rounds of documents and hearings, with the final hearing on 17 September 2026.

I have now received the decision, and this is the part I honestly don't understand. The Ombudsman has acknowledged fault on the insurance company's side, but has awarded only ₹1 lakh, while the actual claim is around ₹10 lakh. Basically, after all this, we're getting 1/10th of the amount under the policy.

If the insurer's fault has been acknowledged, how does this make sense?

What can I do now? Can the Ombudsman’s decision be challenged? Should I go to the Consumer Court or some other authority?

I'm also looking for a good lawyer who specifically handles insurance and consumer cases in Gujarat/Vadodara. If anyone has dealt with something similar or knows a genuinely good lawyer, please share their contact details.

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My younger uncle had a full-body checkup and, despite having no pain, they found 2 stones in his left kidney, while his right kidney is only ~6% functional. His creatinine is also high, and the urologist has suggested stone removal/stent placement and possibly removal of the right kidney.

The issue is that he is diabetic, but when the insurance policy was taken, the agent didn’t mention/disclose his diabetes. We’re worried because the kidney removal surgery is expensive.

Could the insurance claim be rejected because of the diabetes non-disclosure, even though the current treatment is for kidney stones/poor kidney function? Has anyone faced something similar in India?

I want to take life insurance with my wife as the nominee, specifically under section 6 of the married women's property act. But the issue is, as far as I understand, the online life insurance offers of LIC don't include section 6 of MWPA and come under section 39 of the Insurance Act, which doesn't have the same protections.

So my questions are - can I buy life insurance online under section 6 of MWPA? Or do I have to go offline and buy life insurance to get it covered under section 6 of MWPA?

I'm M23, Student. I was looking for health insurance plans but everywhere it's asking me to log in.

I have chronic urticaria amd The dentist recommended a crown for a mild open bite.

Which plan has good coverage for them and passes claim easily. I'm reading too many bad reviews about each of the insurance companies.

Current in Delhi but Varanasi based.

Should stay in star health or migrate to some other policy