ICICI Lombard Health Insurance Claim rejection

[satishveeravalli]

Policy Name

100010239800

Company Name

ICICI Lombard

Customer Care Number

1800 2666

Loss Amount

95000

Ratings

5.00 star(s)

Opposite Party Address

ICICI Lombard

This is the converstion with ICIC Lombard, every time they reject my claim:
"
I wish to inform you that today I have been discharged from Sri Sri Holistic Hospital. Since ICICI Lombard rejected my cashless request, I was left with no alternative but to pay the entire hospitalization expenses from my own pocket to secure my discharge.

This payment has been made under protest and shall not be construed as my acceptance of the rejection of my cashless claim or the reasons stated therein.

I reiterate that:

• I have truthfully disclosed all medical information required at the time of policy issuance.
• I submitted every document requested by your claims team, including the records relating to my 2013 hospitalization and Coronary Angiography (CAG), which clearly established that no coronary artery disease was diagnosed.
• Your rejection letter merely states "Pre-Existing Diseases Not Disclosed – add disease" without identifying the alleged disease, the supporting medical evidence, or how you concluded that I failed to disclose any material fact.

Because of this arbitrary rejection, I have suffered financial loss and mental distress by being compelled to arrange funds for my hospitalization expenses.

I request ICICI Lombard to:

1. Immediately reconsider the rejection of my cashless claim.
2. Treat this communication as an intimation that I have incurred the hospitalization expenses personally due to the wrongful denial of cashless authorization.
3. Process and settle my reimbursement claim for the full admissible amount at the earliest upon submission of the required documents.
4. Provide a detailed written explanation identifying the exact alleged pre-existing disease and all documentary and medical evidence relied upon for rejecting my claim.

I reserve all my legal and contractual rights under the policy and applicable law. My payment to the hospital shall not prejudice any of my rights to seek reimbursement, compensation, or any other remedies available to me.

The hospital bill, payment receipt, discharge summary, and all supporting documents will be submitted along with my reimbursement claim.

Regards,

Veeravalli Satish

Policy No.: 100010239800
Claim No.: 126008163400
Mobile: 9030590029"

I have raised my concern to bimabharosa - still same rejection.

I acknowledge receipt of your email regarding Claim No. 126008163400 under Health Policy No. 100010239800.
I respectfully disagree with the conclusion communicated in your email and request that my claim be reviewed afresh based on the complete medical evidence and the terms of the policy.
1. Change in the Basis of Rejection
The original cashless rejection communicated to the hospital merely stated Pre-Existing Diseases Not Disclosed add disease without identifying any specific disease or providing any supporting medical evidence.
However, your present email now alleges for the first time that the undisclosed condition was Coronary Artery Disease (CAD) with a positive TMT finding.
Kindly explain why this specific allegation was not mentioned in the original rejection letter and why the basis of rejection has changed only after I raised a formal grievance.
2. A Positive TMT is NOT a Disease
Your email states that I had Coronary Artery Disease (CAD) with a positive TMT finding.
I respectfully submit that a Treadmill Test (TMT) is a diagnostic screening investigation and not a disease. A positive TMT is merely a clinical finding that may require further evaluation. It does not, by itself, establish a diagnosis of Coronary Artery Disease (CAD).
During claim processing, I fully cooperated and submitted every document requested by your claims team, including my previous hospitalization records. If ICICI Lombard is alleging that I had a confirmed diagnosis of Coronary Artery Disease prior to the inception of my policy, I request you to provide the documentary and medical evidence relied upon to arrive at such a conclusion.
3. Serious Concern Regarding Incorrect Attribution of Disease
I am deeply concerned that ICICI Lombard has categorically labelled me as suffering from Coronary Artery Disease (CAD) without furnishing any conclusive medical evidence establishing such a diagnosis.
A diagnosis of CAD is a serious medical conclusion that can have significant consequences for an individual future health insurance, life insurance, financial planning, employment opportunities, and permanent medical records.
It is extremely distressing and prejudicial to attribute such a serious disease to a policyholder without substantiating it through clear medical evidence
I request certified copies of all documents relied upon while rejecting my claim, including:
Complete proposal form submitted at policy inception
Underwriting records
Internal claim assessment notes
Medical opinion relied upon by ICICI Lombard
Any independent medical review obtained
All documents relied upon to conclude that I had pre-existing Coronary Artery Disease prior to policy inception.
5. Full and Honest Disclosur
At the time of purchasing this policy, I truthfully disclosed my known medical conditions, including Diabetes and Hypertension, exactly as required during the proposal process.
At no point did I intentionally suppress or misrepresent any material medical information.
If ICICI Lombard alleges otherwise, kindly identify:
The exact question in the proposal form that was allegedly answered incorrectly and
The evidence establishing intentional non-disclosure
I once again request ICICI Lombard to conduct a fair, transparent, and evidence-based review of my claim.
If ICICI Lombard is unable to substantiate its allegation that I had a diagnosed pre-existing Coronary Artery Disease prior to policy inception, I request that the rejection be withdrawn immediately and my claim be processed in accordance with the policy conditions.
In the absence of a reasoned and evidence-supported response, I will have no alternative but to pursue all remedies available under law.

 

[satishveeravalli]

Now they are cancelling the policy without any resolution. Whom to meet and how to get justice for me? can anyone help.

 

[satishveeravalli]

I am posting my experience to seek guidance and to make other policyholders aware of what has happened in my case.


I purchased a health insurance policy from ICICI Lombard in good faith after truthfully disclosing my known medical conditions namely Diabetes and Hypertension. This was my first health insurance policy with ICICI Lombard.


On 26 June 2026 I was admitted to Sri Sri Holistic Hospital Hyderabad on an emergency basis due to severe breathlessness chest discomfort headache and significantly elevated blood pressure. The hospital raised a cashless claim with ICICI Lombard.


ICICI Lombard rejected my cashless claim. Because of this rejection I had no option but to pay the entire hospital bill of more than Rupees One Lakh from my own pocket to obtain my discharge.


The first rejection was vague and merely stated Pre existing condition add disease without identifying which disease was allegedly not disclosed.


After I raised a formal grievance the insurer changed its stand and stated that I had Coronary Artery Disease with a positive TMT finding which according to them had not been disclosed at the time of policy inception.


ICICI Lombard requested my old medical records from 2013. I made every effort to obtain those records and submitted them immediately. The 2013 discharge summary mentions CAD TMT Positive but the same discharge summary also clearly records CAG NORMAL meaning Normal Coronary Angiography.


Despite this important medical finding the insurer never explained how it concluded that I had a confirmed pre existing Coronary Artery Disease requiring disclosure under the proposal form. My repeated requests for the medical opinion underwriting records proposal form and claim assessment records relied upon for rejecting my claim have not been answered.


I also noticed inconsistencies in the insurer responses. In one communication they referred to Coronary Artery Disease with positive TMT. In another communication they again reverted to the vague wording Pre existing condition add disease without identifying the disease. In one grievance response they even mentioned my son name instead of my name creating serious concern whether my grievance had been properly reviewed.


While my grievance before IRDAI Bima Bharosa was still pending ICICI Lombard issued a notice proposing cancellation of my entire health insurance policy alleging misrepresentation at the time of policy inception. They have stated that the policy will be cancelled after 15 days and that the premium will be refunded.


I believe this action is extremely harsh because the dispute regarding my claim is still under challenge. Instead of conducting a fair and transparent review the insurer has proceeded to reject the claim and initiate cancellation of the policy.


At no stage did I intentionally conceal any medical information. I disclosed Diabetes and Hypertension at the time of purchasing the policy. I have fully cooperated throughout the claim process by providing every document requested including my old medical records.


I have now escalated the matter before IRDAI through the Bima Bharosa portal and am also pursuing my remedies before the Insurance Ombudsman. If necessary I will also approach the appropriate Consumer Commission.


My purpose in posting this is to seek advice from members who have faced similar situations and to understand whether anyone has successfully challenged a health insurance policy cancellation based on alleged non disclosure of an old medical record.


I would appreciate any guidance from legal experts insurance professionals or policyholders who have handled similar disputes.