Health Insurance Formal Consumer Complaint – Harassment, Delay & Wrongful Claim Rejection (Claim ID 1122585258254 | Policy No 31-25-0071561-00)

N

Nikesh

New member
Policy Name
Aditya Birla Health Insurance – Activ One NXT
Company Name
Aditya Birla
Customer Care Number
1800-270-7000
Loss Amount
335000
Ratings
1.00 star(s)
Opposite Party Address
Registered & Head Office:
Aditya Birla Health Insurance Co. Ltd.
Aditya Birla Centre, S. K. Ahire Marg, Worli, Mumbai – 400 030, Maharashtra, India.
Complainant: Nikesh Kumar Manhar (on behalf of Miss Khushi Rani, 20 yrs)
Policy: Aditya Birla Health Insurance – Activ One NXT
Claim ID: 1122585258254 Member ID: PT25863390
Contact: 7828173845 Email: nikesh.manhar@gmail.com
Address: Bilaspur, Chhattisgarh



Summary of Grievance​


I am filing this complaint against Aditya Birla Health Insurance Co. Ltd. and PolicyBazaar Insurance Web Aggregator for harassment, procedural negligence, and wrongful claim repudiation.


  • Policy ported from Star Health → Aditya Birla on 23-May-2025 via PolicyBazaar.
  • Minor RTA on 25-Apr-2025 (no fracture, no diagnosis, no hospitalization).
  • AVN diagnosis in June 2025 → Surgery at Yashoda Hospital (27–29 Jul 2025).
  • Claim ₹ 3,35,285 submitted 25-Aug 2025.
  • SMS received: “Since the claim is payable ₹ 552 deducted for premium.”
  • After 90 days of silence, claim rejected on 12-Nov-2025 under Clause E.1.14(a) – pre-policy accident.

The accident produced no medical diagnosis and AVN was detected after policy inception.
Both Aditya Birla and PolicyBazaar repeated only automated “under process” responses, denied access to the medical review team, and gave no written reasoning for repudiation.


This constitutes deficiency in service and unfair trade practice, violating:


  • IRDAI Reg. 17(1) – non-disclosure cannot justify rejection without proven fraud,
  • Insurance Act § 45 – misrepresentation must be intentional and material,
  • Consumer Protection Act § 2(1)(g) – misleading communication = service deficiency.


Reliefs Requested​


  1. Immediate reversal of repudiation and settlement of ₹ 3,35,285 + pharmacy bills.
  2. Written medical review report and apology from Aditya Birla.
  3. Inquiry into PolicyBazaar’s negligence during porting.
  4. Compensation for mental agony and financial loss.
  5. Confirmation that Clause E.1.14(a) will not be misused for post-policy conditions.


Attachments (upload as PDFs/JPGs)​


  • Policy copy + ID card
  • Claim submission + query letters
  • Repudiation letter (12-Nov-2025)
  • MRI & discharge summary
  • Doctor certificates and NOC
  • “Claim payable” SMS screenshot
  • Timeline chart and call logs
 

Attachments

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