Sanchay Dosi accuses HDFC ERGO of unfairly rejecting a valid pneumonia hospitalization claim despite paying ₹1 lakh annual premium. Learn about legal remedies, complaint filing process, and how Choice4Voice.com helps policyholders fight insurance disputes.
Complaint Summary
| Details | Information |
|---|---|
| Complainant Name | Sanchay Dosi |
| Company/Brand | HDFC ERGO General Insurance |
| Complaint Type | Unfair Insurance Claim Rejection |
| Product/Service | Health Insurance Policy |
| Premium Paid | ₹1,00,000 annually |
| Hospital | Pragati Hospital, Dahisar (E) |
| Issue Description | Claim denied twice despite CT scan confirming pneumonia |
| Company’s Response | Rejected citing “discrepancies in documents”; demanded family letter |
Full Complaint Details
Sanchay Dosi, Founder of Param Corporation, shared his frustration over HDFC ERGO General Insurance’s claim handling process.
On 22nd September, his mother was admitted to Pragati Hospital, Dahisar (E) with fever, chills, and headache. Trusting his insurer, he applied for a cashless claim.
- 23rd September – First claim was declined citing “document discrepancies.”
- 25th September – Even after a CT scan confirmed pneumonia, the second claim was rejected using the same excuse.
- The insurer even forced his sister to write a detailed medical condition letter, which Sanchay described as harassment in a stressful situation.
Despite paying ₹1 lakh premium every year, the complainant alleges that HDFC ERGO used loopholes to avoid paying valid claims. He expressed deep regret for trusting and recommending the insurer to others, calling the experience a “trap, not insurance.”
Which Brand is Involved
HDFC ERGO General Insurance Company Ltd.
- Joint venture between HDFC Ltd. and ERGO International AG (Munich Re Group, Germany).
- Established in 2002, headquartered in Mumbai.
- Offers health, motor, travel, home, and corporate insurance.
- Marketed as one of India’s most trusted insurers, but also faces recurring consumer complaints about delayed or unfair claim rejections.
Customer Care Contact:
- Email: care@hdfcergo.com
- Toll-Free: 1800-2700-700
- Website: www.hdfcergo.com
Solutions Expected
The complainant demands:
- Approval of the valid hospitalization claim.
- Immediate settlement of medical expenses incurred.
- Apology for harassment and undue stress caused to the family.
- Policy reforms to prevent harassment of policyholders during claim filing.
Legal Options Available
Policyholders facing wrongful claim denials can seek remedies under:
- IRDAI (Insurance Regulatory and Development Authority of India)
- File complaint on IRDAI IGMS portal (igms.irda.gov.in).
- Insurance Ombudsman (Bimalokpal)
- File complaint in prescribed format for disputes up to ₹30 lakh.
- Consumer Protection Act, 2019
- File case in Consumer Disputes Redressal Forum for deficiency in service.
- Indian Penal Code (IPC)
- Sections 417 & 420 for cheating and misrepresentation.
- Contract Act & IRDAI Guidelines
- Non-settlement of genuine claims violates principles of good faith and fair dealing.
Departments & Authorities for Filing Complaints
- IRDAI Grievance Cell – Email: complaints@irdai.gov.in | Helpline: 155255
- Insurance Ombudsman – File through ecoi.co.in
- National Consumer Helpline (NCH) – 1800-11-4000 | consumerhelpline.gov.in
- Consumer Court – Online filing at edaakhil.nic.in
- District Consumer Forum (CDRC) – Jurisdiction based on complainant’s residence or hospital location
How Choice4Voice.com Can Help
At Choice4Voice.com, we amplify the concerns of consumers like Sanchay Dosi who are ignored by big insurers:
- Publish complaints with evidence to pressure insurers for resolution.
- Provide step-by-step legal filing guides for IRDAI, Ombudsman, and consumer forum.
- Share draft complaint templates for IRDAI IGMS, Ombudsman, and Consumer Forum petitions.
- Highlight such cases on LinkedIn and digital media, giving consumers a strong public voice.
- Assist in connecting with legal experts if escalation to court is required.
Step-by-Step Guide to File a Complaint Against HDFC ERGO
- Raise Complaint with HDFC ERGO via email and customer care (obtain ticket number).
- File on IRDAI IGMS Portal – Attach policy copy, hospital bills, rejection letters.
- Escalate to Insurance Ombudsman – Submit prescribed form via ecoi.co.in.
- Register with National Consumer Helpline – Seek mediation support.
- File Consumer Forum Case (CDRC) – For reimbursement + compensation for harassment.
SEO-Optimized Q&A Section (20 Questions)
Q1. Why did HDFC ERGO reject Sanchay Dosi’s claim?
They cited “document discrepancies” despite CT scan confirmation of pneumonia.
Q2. Can insurance companies demand family-written medical letters?
No, this is not a standard requirement and may amount to harassment.
Q3. How to file a complaint against HDFC ERGO?
First approach the insurer, then escalate via IRDAI IGMS or Insurance Ombudsman.
Q4. What is IRDAI IGMS?
An online grievance management system for policyholders to register complaints.
Q5. Can the Insurance Ombudsman handle health insurance disputes?
Yes, for claims up to ₹30 lakh.
Q6. How long does IRDAI take to resolve a complaint?
Generally 30–60 days.
Q7. Can a consumer sue HDFC ERGO for mental harassment?
Yes, under the Consumer Protection Act, 2019.
Q8. Is rejecting valid medical claims legal?
No, it violates IRDAI’s fair practices guidelines.
Q9. Can I claim interest on delayed insurance payments?
Yes, consumer forums often award interest on delayed settlements.
Q10. What proof is required for filing insurance complaints?
Hospital bills, rejection letters, medical records, policy documents.
Q11. Is non-disclosure a valid reason for claim rejection?
Only if it is material to the illness being treated, not otherwise.
Q12. Can I file a complaint online against HDFC ERGO?
Yes, through IRDAI IGMS, ecoi.co.in, or edaakhil.nic.in.
Q13. What if the insurer ignores my complaint?
Escalate to Insurance Ombudsman or Consumer Forum.
Q14. What compensation can I claim in consumer court?
Reimbursement, litigation costs, and damages for harassment.
Q15. Is Sanchay Dosi’s case an example of unfair trade practice?
Yes, as the insurer allegedly denied a genuine claim.
Q16. Can Choice4Voice.com help with insurance complaints?
Yes, by amplifying cases, guiding legal remedies, and providing templates.
Q17. What is the helpline number for IRDAI?
155255 (toll-free).
Q18. Can I directly approach consumer court without IRDAI?
Yes, consumers can directly file at CDRC.
Q19. How to identify insurance claim rejection frauds?
Look for repetitive excuses, vague reasons, and refusal to provide evidence.
Q20. Can insurance companies be penalized for wrongful rejections?
Yes, IRDAI can impose fines and courts can award compensation.
