Pawan Kumar Goel
New member
- Loss Amount
- 103000
- Ratings
Before Hon'ble district consumer court Disputes Redressal Commission, Dehradun, Uttarakhand
Consumer Complaint No. 1.....of 2026
Pawan Kumar Goel, Age-72 Years, S/O Late Sita Ram Goel, Res. at: 463/1, lane-4, Street-8,Rajenderanagar , Dehradun. 248001, Mob. 8126487651,E-mail- pkgoel12@gmail.com . ....................Complainant
Versus.
ICICI LOMBARD Health Care General Insurance, 4th floor, Varun Towers-II, Opp. Hyderabad Public School , Begumpet, Hyderabad,
Telangana-500016 ,Toll Free Tel. no.18002666 , grievance redressal cell E-mail-servicequality@icicilombard.com.................... Opposite Party
Reference: Final Notice of Lodged complaint to ICICI Lombard Grievance Cell as below
Ms.Binsy Soni
Grievance Redressal Manager - ICICI Lombard Date: 24.05.2026
Ref.: Reg.: Policy No.100025511700, Claim No.226000731900,Total claim Amount Rs.103000.00
I was admitted to Star Hospital, Hyderabad , India on date 30.01,2026 and discharged on 02.02.2026.for the treatment of Angioplasty procedure in Heart Main Artery. Despite submitting all valid medical records, original bills and Discharge summaries, my genuine claim was arbitrarily rejected on the grounds of Pre-existing condition not disclosed. I already briefed you that AVM Embolization RBBBLAH is a natural available condition and not any disease. Medically not suggested any type of medicine .Neither related to Heart concerning treated
problems. Only u made a rejection on the basis of non disclosure as per yr clause general T&C. Please note that this rejection is completely baseless, illegal and constitutes a gross Deficiency in Service under the consumer Protection Act,2019.Your company can not deny liability for a sudden, active medical treatment required by a qualified doctor. Moreover I am being compelled by you by saying "We would like to inform you policy will be cancelled only on a pro rata basis only with approximate refund amount of Rs.17554/-" while I did not request you for cancellation.
I hereby call upon your office to review this matter and reverse the rejection decision, setting the full amount of Rs.1.03 Lakh in to my registered bank account within 7 business days from the receipt of this email. If the amount is not credited within the stipulated time, I will be compelled to initiate formal legal proceedings against your company in the DCDRC, Dehradun, without any further correspondence. Please note that in the full claim amount of Rs.1.03.000 along with 12% interest, compensation for mental agony, and full litigation costs.
Kindly treat this email as a formal legal notice prior to litigation.
Yours sincerely,
Pawan Kumar Goel
81264875651
463/1, Lane-4, Street-8
Rajendranagar,
Dehradun-248001
Reply Received from ICICI Lombard as below
servicequality@icicilombard.com
May 26, 2026, 10:34 PM
to me
Dear Mr. Goel,
We have carefully reviewed your case regarding the claim number 226000731900.
After assessment, this is to inform you that the claim request cannot be accepted and our stance remains the same.
Reason – The patient was diagnosed with a pre-existing condition AVM Embolization, RBBBLAH. , which was not declared when the policy was issued, hence claim rejected. Refer to ''e. GENERAL Terms and CONDITIONS, i. Standard General Terms and clauses, 1. Disclosure of Information'' Section of your policy wordings.
Further, you had requested refund of premium; accordingly, we had informed you that a prorated amount can be refunded subject to cancellation of the policy.
Given the above understanding, we are closing your email with reference number 03-26-011325.
Please be assured that your query was thoroughly reviewed in line with your policy coverage.
We look forward to continuing to serve you.
Warm regards,
Binsy Soni
Grievance Redressal Manager - ICICI Lombard
Toll free no.18002666
servicequality@icicilombard.com
customersupport@icicilombard.com
Prayer
ICICI Lombard is not accepting my claim of Rs.103000/- request unethically and unlawfully on the basis of unjustified reason of undeclared precondition AVM( Nerves small Bunch) in lower Pelvis area, which is a natural available body condition and not harmful to my Heart and other body parts . Also this is not medically related to any medicine and by angiography treated Heart main Artery Part which is covered under this super top up health policy of Rs.20.00 Lakh. Instead Company has declared that due to said reason, policy is not valid and hence cancelled. Only Rs.17500/- can be refunded on Prorated basis against my Annual Premium deposited of Rs. 29550/-on 28.10.2025. Policy Validity period is up to 28.10.2026. Neither company is giving me my justified claim nor refunding full deposited premium as company has declared my existing policy is invalid. I consider it a great injustice to me. Therefore, my humble appeal to you to give me yr kind Justice from your Hon'ble consumer court under consumer protection act . All above are true version to the best of my knowledge.
Thanking you in anticipation.
Complainer
Pawan Kumar Goel
463/1, lane no 4, Street no.8 Rajendernagar
Dehradun 248001
Mob.8126487651, email.-pkgoel12@gmail.com
Consumer Complaint No. 1.....of 2026
Pawan Kumar Goel, Age-72 Years, S/O Late Sita Ram Goel, Res. at: 463/1, lane-4, Street-8,Rajenderanagar , Dehradun. 248001, Mob. 8126487651,E-mail- pkgoel12@gmail.com . ....................Complainant
Versus.
ICICI LOMBARD Health Care General Insurance, 4th floor, Varun Towers-II, Opp. Hyderabad Public School , Begumpet, Hyderabad,
Telangana-500016 ,Toll Free Tel. no.18002666 , grievance redressal cell E-mail-servicequality@icicilombard.com.................... Opposite Party
Reference: Final Notice of Lodged complaint to ICICI Lombard Grievance Cell as below
Ms.Binsy Soni
Grievance Redressal Manager - ICICI Lombard Date: 24.05.2026
Ref.: Reg.: Policy No.100025511700, Claim No.226000731900,Total claim Amount Rs.103000.00
I was admitted to Star Hospital, Hyderabad , India on date 30.01,2026 and discharged on 02.02.2026.for the treatment of Angioplasty procedure in Heart Main Artery. Despite submitting all valid medical records, original bills and Discharge summaries, my genuine claim was arbitrarily rejected on the grounds of Pre-existing condition not disclosed. I already briefed you that AVM Embolization RBBBLAH is a natural available condition and not any disease. Medically not suggested any type of medicine .Neither related to Heart concerning treated
problems. Only u made a rejection on the basis of non disclosure as per yr clause general T&C. Please note that this rejection is completely baseless, illegal and constitutes a gross Deficiency in Service under the consumer Protection Act,2019.Your company can not deny liability for a sudden, active medical treatment required by a qualified doctor. Moreover I am being compelled by you by saying "We would like to inform you policy will be cancelled only on a pro rata basis only with approximate refund amount of Rs.17554/-" while I did not request you for cancellation.
I hereby call upon your office to review this matter and reverse the rejection decision, setting the full amount of Rs.1.03 Lakh in to my registered bank account within 7 business days from the receipt of this email. If the amount is not credited within the stipulated time, I will be compelled to initiate formal legal proceedings against your company in the DCDRC, Dehradun, without any further correspondence. Please note that in the full claim amount of Rs.1.03.000 along with 12% interest, compensation for mental agony, and full litigation costs.
Kindly treat this email as a formal legal notice prior to litigation.
Yours sincerely,
Pawan Kumar Goel
81264875651
463/1, Lane-4, Street-8
Rajendranagar,
Dehradun-248001
Reply Received from ICICI Lombard as below
servicequality@icicilombard.com
May 26, 2026, 10:34 PM
to me
Dear Mr. Goel,
We have carefully reviewed your case regarding the claim number 226000731900.
After assessment, this is to inform you that the claim request cannot be accepted and our stance remains the same.
Reason – The patient was diagnosed with a pre-existing condition AVM Embolization, RBBBLAH. , which was not declared when the policy was issued, hence claim rejected. Refer to ''e. GENERAL Terms and CONDITIONS, i. Standard General Terms and clauses, 1. Disclosure of Information'' Section of your policy wordings.
Further, you had requested refund of premium; accordingly, we had informed you that a prorated amount can be refunded subject to cancellation of the policy.
Given the above understanding, we are closing your email with reference number 03-26-011325.
Please be assured that your query was thoroughly reviewed in line with your policy coverage.
We look forward to continuing to serve you.
Warm regards,
Binsy Soni
Grievance Redressal Manager - ICICI Lombard
Toll free no.18002666
servicequality@icicilombard.com
customersupport@icicilombard.com
Prayer
ICICI Lombard is not accepting my claim of Rs.103000/- request unethically and unlawfully on the basis of unjustified reason of undeclared precondition AVM( Nerves small Bunch) in lower Pelvis area, which is a natural available body condition and not harmful to my Heart and other body parts . Also this is not medically related to any medicine and by angiography treated Heart main Artery Part which is covered under this super top up health policy of Rs.20.00 Lakh. Instead Company has declared that due to said reason, policy is not valid and hence cancelled. Only Rs.17500/- can be refunded on Prorated basis against my Annual Premium deposited of Rs. 29550/-on 28.10.2025. Policy Validity period is up to 28.10.2026. Neither company is giving me my justified claim nor refunding full deposited premium as company has declared my existing policy is invalid. I consider it a great injustice to me. Therefore, my humble appeal to you to give me yr kind Justice from your Hon'ble consumer court under consumer protection act . All above are true version to the best of my knowledge.
Thanking you in anticipation.
Complainer
Pawan Kumar Goel
463/1, lane no 4, Street no.8 Rajendernagar
Dehradun 248001
Mob.8126487651, email.-pkgoel12@gmail.com