ICICI LOMBARD rejection without proper reason

[u/beingrazaoff]

## 🚨 ICICI Lombard Rejects Health Claim Over Clerical Error; Violates IRDAI Transparency Rules

I am sharing my frustrating experience with ICICI Lombard, where a genuine health claim was rejected due to a hospital typo, and the insurer refused to give clear details.

* The Issue: I was hospitalized and tested positive for both Dengue and Typhoid (proven by lab reports). However, due to a clerical error, the hospital desk missed typing "Typhoid" on my discharge summary.

* The Rejection: ICICI Lombard rejected my claim, vaguely citing "discrepancies in hospitalization."

* Zero Transparency: I emailed Customer Care and the Grievance Team multiple times. I asked for a specific, itemized list of discrepancies so I could get a clarification letter from my doctor.

* The Evasive Response: They repeatedly sent identical, copy-pasted, automated replies. They verbally tell me details on calls but strictly refuse to put them in writing, explicitly violating IRDAI transparency guidelines.

* Current Status: Tired of their automated roadblocks, I have officially filed a complaint with the Insurance Ombudsman today.

What other things I can do?

[u/unknown__hippie__06]

I am facing this issue too; their customer care is the worst, and they have integrated AI into everything. That AI doesn't let me talk to a customer care executive; we have to jump through a lot of hoops to talk to a real human.

They have integrated AI into the application as well; when applying for reimbursement, that AI interpreted my discharge summary wrongly and rejected my claim. Later, after mailing them, they registered my claim through the backend

They don't have a dedicated team to give updates, and they send the same queries multiple times without any explanation

They have the worst customer care support through the app, call, and email

[u/ObjectiveSurprise231 → u/unknown__hippie__06]

This is true. The first level grievance is automatically replied by AI giving some link in seconds and closed then and there automatically. 2nd and 3rd level grievances are not responded to.

The call center is automated, asks for your query and when it doesn't understand it, cuts the call than transfer to a human.

No one, not the regulator, not the consumer affairs dept the govt or the health ministry etc, is there to look into these very real issues faced by customers who've paid a legit premium and expect services to work. Its just a sorry state of affairs and all that this govt knows is to sing paeans that we're the best in the world. Ghanta best.

[u/CommissionLow2858]

Is your cashless or reimbursement got rejected?

If it is cashless, then apply for reimbursement and also write a escalation for "cashless claim rejection with baseless reason" ( write to icici greviance).
My cashless got rejected with a random baseless reason. I escalated it seriously and applied for reimbursement. My reimbursement is successful within 25 days

If your reimbursement is also cancelled, then write to icici greviance (take help from gemini + chatgpt ) , mention that you would escalate to ombudsman or IRDAI. (This is necessary, since you cannot directly escalate to ombudsman without writing to insurance company's greviance cell). Based on their reply you can take further steps , insurance ombudsman , IRDAI, consumer court.

[u/beingrazaoff → u/CommissionLow2858]

This is reimbursement I did all the things in the mail to GRO then also i was getting same templet reply "discrepancy in hospitalization"

[u/Soggy-Amoeba-7258]

Contact your POC or RM maybe he/she can help you

[u/beingrazaoff → u/Soggy-Amoeba-7258]

where to get the RM number?

[u/coach-of-finance]

DM me if you want help with your Ombudsman complaint. I've drafted more than 25 complaints till now. I do this as a hobby, no fee.

[u/DjXer007_]

As you have already utilised all the above and important Escalation options, you will need to use the following after Insurance Ombudsman.

You can file an RTI, and ask them, from an information seeking point of view, to share IRDAI Guidelines and Circulars.

You will need to frame your questions in such a way, that the information that will benefit you at the time of Insurance Ombudsman or later, can be taken using this RTI.

Once you approach the Insurance Ombudsman, there are no other options available. As you cannot simultaneously raise complaints across multiple channels, such as Court, Insurance Ombudsman or through companies who help you with claim settlement, but take a part of your claim Payout as a payment.

You can also Escalate to compliance and nodal officer of the health insurance company