Hdfc Ergo General Health Insurance Co. Ltd
- Wrongful rejection of Health Insurance Claim Open
On 17th July 2018, I was detected for symptomatic Cholelithiasis & was advised Laparoscopic Cholecystectomy. I underwent a surgical operation at Artemis Hospital Gurgaon on 10th August 2018.
b. I filed a claim for reimbursement of expenses to HDFC Ergo on 14th Aug 2018 which has been rejected by Co. citing section D 3 of policy, for lack of a waiting period of 2 years applicable for the said ailment and procedure.
c. I am a senior citizen based in Gurgaon. I have been taking Health Insurance policies for the past many years - 2015-16, 2016-17 with Religare Health, 2017-18 with Max health and 2018-19 with HDFC Ergo. In the past 3 years, I have not had the need to take any insurance claim.
d. In March 2018, I opted for HDFC Ergo on-line through Easypolicy Insurance Web Aggregators Pvt. Ltd. There was no query raised from Easy Policy Aggregators or HDFC ERGO Insurance Company regarding my previous Insurance policies while my policy request was processed after a health examination and policy was issued on 26.03.2018.
e. As per Govt. Of India circular IRDA/HLT/MISC/CIR/030/02/2011 Date: 10-02-2011,
"All insurers issuing health insurance policies shall allow for credit gained by the insured for
pre-existing condition(s) in terms of waiting period when he/she switches from one insurer to another or from one plan to another, provided the previous policy has been maintained without break".
f. As I have been insured uninterruptedly with Insurance companies for the past 4 years, since 26th March 2015, I have the right to claim insurance amount. HDFC ERGO is fully responsible to reimburse my medical care expenses which it has wrongly repudiated.
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