- Wrongful rejection of Health Insurance Claim ^Open

VIRENDRA GUPTA filed this complaint against Hdfc Ergo General Health Insurance Co. Ltd on Apr 24, 2019

Resolution Demanded:
Damages

On **th July ****, I was detected for symptomatic Cholelithiasis & was advised Laparoscopic Cholecystectomy. I underwent a surgical operation at Artemis Hospital Gurgaon on **th August ****.

b. I filed a claim for reimbursement of expenses to HDFC Ergo on **th Aug **** which has been rejected by Co. citing section D * of policy, for lack of a waiting period of * 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 - ****-**, ****-** with Religare Health, ****-** with Max health and ****-** with HDFC Ergo. In the past * years, I have not had the need to take any insurance claim.

d. In March ****, 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 **.**.****.

e. As per Govt. Of India circular IRDA/HLT/MISC/CIR/***/**/**** Date: **-**-****,
"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 * years, since **th March ****, 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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