A senior HR professional shares her harrowing experience where ICICI Lombard approved her medical insurance claim twice and later rejected it without any valid explanation. Here’s the full complaint and what every policyholder should know.
Consumer Complaint Summary
| Complainant | Jyoti Pandey |
|---|---|
| Current Role | Assistant Manager, Human Resources |
| Company | Orbis Financial Corporation Limited |
| Complaint Against | ICICI Lombard General Insurance |
| Claim Nos. | 220204258308 & 220204258308-1 |
| Claim Amount | ₹4,27,721 |
| Amount Approved | Only ₹30,625 |
| Hospital | Sir Ganga Ram Hospital, Delhi |
| Duration of Delay | Over 2.5 months |
| Primary Concern | Claim initially approved and later denied without valid reason |
The Full Story: Claim Approved, Then Rejected Without Justification
Jyoti Pandey, an HR professional and verified LinkedIn user, recently posted her traumatic experience with ICICI Lombard General Insurance. After a life-threatening health emergency and multiple approvals from the insurer, her insurance claim was unexpectedly denied forcing her to pay out of pocket and struggle for reimbursement for months.
The emergency occurred at Sir Ganga Ram Hospital, where she was admitted with critically low hemoglobin and platelet levels and placed in the ICU for three days.
Despite these alarming conditions:
- ICICI Lombard approved the claim twice once for ₹58,400 and again for ₹48,114.
- The hospital received no payment during admission, and the patient had to cover the costs herself.
- She was later told to apply for reimbursement, which was partially paid after 2.5 months, with no explanation for the massive deduction.
- Only ₹30,625 was reimbursed against a total bill of ₹4.27 lakh.
What the Complainant Is Demanding
In her public post, Jyoti has made a firm request to ICICI Lombard to:
- Re-evaluate the claim amount with proper medical documentation review.
- Provide a clear and written explanation for the denial.
- Take accountability for poor service and ensure such failures don’t affect others.
She has further warned of escalation to:
- IRDAI (Insurance Regulatory and Development Authority of India)
- Insurance Ombudsman
- Other consumer forums and legal avenues if the matter remains unresolved.
10 Most Searched Questions About Health Insurance Claim Rejections
1. Why was my health insurance claim denied even after pre-approval?
Insurance claims may still be denied due to internal review errors, policy exclusions, or lack of documentation. However, once pre-approved, rejection without a valid reason is highly questionable and should be challenged.
2. Can an insurance company reject a claim after it has been approved?
No, unless there’s evidence of fraud, non-disclosure, or policy violation, a previously approved claim cannot be arbitrarily rejected. The insurer must provide clear reasons in writing.
3. What should I do if my health insurance claim is rejected?
You should:
- Request the written reason for rejection.
- File a formal complaint with the insurer.
- Escalate to IRDAI or the Insurance Ombudsman if unresolved.
4. How long does ICICI Lombard take to settle a reimbursement claim?
Ideally, ICICI Lombard should settle claims within 15–30 working days. If your claim is delayed beyond this, you have the right to seek clarification or escalate.
5. How can I file a complaint against ICICI Lombard?
You can:
- Email ICICI Lombard’s Grievance Redressal Officer.
- Use the IRDAI IGMS platform (www.igms.irda.gov.in).
- File a case with the Insurance Ombudsman.
- Publish your case on Choice4Voice.com to create public awareness.
6. What is the role of the Insurance Ombudsman in India?
The Insurance Ombudsman is a quasi legal body that helps resolve policyholder grievances related to claims, policy lapses, and mis-selling free of cost.
7. Is ICU treatment covered under health insurance?
Yes, ICU treatment is generally covered under most health insurance policies, provided it meets the terms and is medically justified.
8. Why do cashless claims sometimes get rejected at the last minute?
Cashless claim rejection can happen due to:
- Misinterpretation of documents.
- Incomplete medical reports.
- Internal audit concerns.
However, pre-approved claims should not be reversed without a valid cause.
9. Can I go to consumer court for insurance claim issues?
Yes, if all other avenues fail, you can approach the District Consumer Forum or State Consumer Commission depending on the claim amount and nature of grievance.
10. What platforms can help me raise my insurance complaint publicly?
You can use:
- LinkedIn to tag company leadership.
- Choice4Voice.com to document and highlight the issue.
- Other consumer-focused websites like Consumer Complaints Court, Jago Grahak Jago, or Twitter (X).
Why This Case Matters
This isn’t just one individual’s experience. Jyoti’s ordeal reflects a broader pattern of customer dissatisfaction and distrust in the private insurance sector. Many people pay high premiums every year expecting protection during medical crises only to be left helpless when they need it most.
Choice4Voice.com’s Role in Amplifying Consumer Voices
At Choice4Voice.com, we believe every genuine complaint deserves to be heard. We publish verified grievances against corporations to ensure they don’t go unnoticed or unresolved. Our mission is to:
- Give power back to the consumer
- Hold companies accountable publicly
- Ensure timely redressal through digital pressure
If you’ve faced similar issues with ICICI Lombard or any other insurer, submit your complaint to us at:
Final Note
This article is based on a public complaint shared by Jyoti Pandey on LinkedIn. All details presented are her firsthand account. ICICI Lombard is welcome to issue a clarification, and we will publish it in full fairness and transparency.
