satishveeravalli
New member
- Policy Name
- 100010239800
- Company Name
- ICICI Lombard
- Customer Care Number
- 1800 2666
- Loss Amount
- 95000
- Ratings
- 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 request ICICI Lombard to:
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.
"
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.
I request ICICI Lombard to:
- Immediately reconsider the rejection of my cashless claim.
- Treat this communication as an intimation that I have incurred the hospitalization expenses personally due to the wrongful denial of cashless authorization.
- Process and settle my reimbursement claim for the full admissible amount at the earliest upon submission of the required documents.
- Provide a detailed written explanation identifying the exact alleged pre-existing disease and all documentary and medical evidence relied upon for rejecting my claim.
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.
