ICICI Lombard Health Insurance Cheats its Customer in Emergency
ICICI Lombard Health Policy promoters spend very lavishly on their advertisements in the multiple digital and print media portals, of the unmatched benefits and achievements of their efficacies, often misleading the common people and readers to believe that they go out of their way to help their policy holders in distress. However, here is an example how they go out of their ways to cause distress to their policy holders. This article is an expose of the ICICI Lombard Health Insurance that boasts itself as one of the best in the nation. In this case, they left their cashless policy holder patient admitted to a hospital in grave emergency high and dry. They not only denied the settlement of the bills with the hospital, but also declared the policy null & void on false pretext when it was needed the most.
Mr V (actual name changed for confidentiality), a 32 yr, young, fully fit senior executive with a tech company in Bangalore for nearly 10 yrs had held various health insurance policies in past but never required any re-imbursement or bill settlement with any of them. In the year 2023 looking at the misleading advertisements, he changed his health policy from previous insurer to the ICICI Lombard impressed by their online advertisements that apparently showed it to be superior to others.
On 19 Sep 2024, Mr V fell seriously ill with an acute high fever, excruciating joint and disabling muscle pains all over the body to the extent that he could not even change his posture while lying in the bed. His father and wife being doctors, were puzzled with this acute illness. They first tried with symptomatic treatment but that didn’t work. Next morning his father suggested for few common blood tests before taking him to a hospital. Patient’s wife, a doctor herself requisitioned for the standard tests and paid the prescribed fees. The test reports were available by the evening of the same day and indicated no specific disease. With no relief in his clinical condition, the patient was taken to Vaidehi Hospital in Bangalore. The Emergency department tried with initial management carrying out some additional tests. All those tests were also negative but the patient was in great pains. Hence, they suggested admission and inpatient care. Admission process was completed by paying Rs 5000/-as advance with the cashless ICICI Lombard policy process initiated.
The specialist physicians were able to alleviate the condition of the patient in 2 days and felt that the further course of treatment could be pursued at home. He was recommended discharge on 23 Sep 24. An ICICI evaluator came to pursue hospitalization document. The evaluator erroneously gave a report that the patient was having pre-existing diabetes and not only rejected the caseless hospital claim settlement but also held the policy null & void. It was a false allegation by the evaluator. ICICI Lombard accepted evaluator’s report without any confirmatory test for diabetes. Patient although partially incapacitated, tried to explain them that he didn’t have diabetes but they refused. Even the treating doctors of that hospital certified that there was no evidence of diabetes in the patient, but ICICI Lombard refused to take note of it. The patient, an executive himself, used his credit card to pay the hospital bills and left. One wondered as to what had happened if the policy holder didn’t have the means to pay such large hospital bills.
After coming back home, the patient again tried to claim re-imbursements of the hospitalization bills but ICICI Lombard refused. Of course, he has decided to contact a lawyer to file case against ICICI Lombard BUT the insensitivity that the insurance company has shown, is unpardonable. How can they refuse any claim for an unsubstantiated and false observation of the evaluator? Since the case is genuine and authentic, ICICI will have to pay additionally incl the legal fees as well as compensation for the harassments caused to the patient. It was totally uncalled for an insurance company apparently of high repute. The evaluator should have made effort to confirm or substantiate his observation. Further, after the error was brought to the notice of the insurance company, they should have been objective in asking the evaluator for confirmatory evidence for the allegations BUT they did not.
The above example shows how insensitive the promoters of Insurance Companies are. Such Insurer must be taken to task for their illogical approach and harassment caused to their customer policy holders.