Kumar K shares his shocking experience with Generali Central Life Insurance WTW where a corporate health insurance claim was wrongly deducted at 20% instead of 10%. This unfair practice forced him to pay ₹43,000 extra during his mother’s surgery. His case highlights the importance of consumer awareness in health insurance claims.
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Complaint Summary : Generali Insurance Complaint – Kumar K’s Corporate Health Claim Wrongly Deducted ₹43,000
| Customer Name | Kumar K |
|---|---|
| Designation | Sr. Engineering Specialist at BT |
| Company/Brand | Generali Central Life Insurance WTW (formerly Liazon) |
| Complaint Type | Wrong Claim Deduction in Corporate Health Insurance |
| Claim Number | 12-FGH-25-3-872777-01 |
| Incident | Mother’s surgery claim settlement |
| Expected Deduction | 10% co-pay = ₹33,466 |
| Actual Deduction | 20% co-pay = ₹76,000 |
| Overcharge Amount | ₹43,000 |
| Resolution Offered | Refund promised after 4–5 working days |
| Original Post URL | LinkedIn Source |
Detailed Write-Up
Background of the Complaint
Health insurance is supposed to ease the financial burden of medical emergencies. However, in Kumar K’s case, his corporate health insurance policy with Generali Central Life Insurance WTW turned into an additional source of stress.
When his mother underwent surgery, the hospital claim settlement showed a 20% co-pay deduction instead of the policy-stated 10%. This error forced him to pay ₹76,000 upfront, nearly ₹43,000 more than required.
The Immediate Impact
At a time when families should focus on a patient’s recovery, Kumar was left juggling between hospital authorities and insurance teams. Instead of offering timely support, the insurer initially stood by their calculation until he repeatedly challenged the error.
After hours of calls and escalations, the insurance company finally admitted the mistake and promised a refund within 4–5 working days.
Why This Case is Important
This case raises serious concerns:
- System Errors or Negligence – A corporate insurance provider applying double the correct deduction rate is not a small mistake.
- Financial Stress During Emergencies – Families already under emotional pressure are forced to arrange unexpected funds.
- Silent Losses for Consumers – Not everyone cross-checks their hospital bills. Many may have lost significant amounts without realizing.
Key Lessons for Consumers
Kumar K ended his post with a strong awareness message for all policyholders:
- Always verify hospital bills against insurance approvals.
- Never assume insurance teams are always accurate.
- Raise your voice until your issue is resolved.
This complaint highlights why consumer vigilance is crucial in India’s healthcare and insurance ecosystem.
Why This Complaint Matters for Generali Central Life Insurance
- Trust at Stake: Insurance works on consumer trust. Such errors can permanently damage the company’s reputation.
- Regulatory Oversight: As per IRDAI guidelines, insurers must ensure fair, transparent, and error-free settlements.
- Corporate Accountability: Since this was a corporate group health policy, the issue also raises questions about employer oversight in protecting employees’ interests.
Consumer Rights and Escalation Options
If such cases are not resolved fairly, consumers have the right to escalate their grievances:
- Internal Grievance Cell of Generali Insurance – First step for official redressal.
- IRDAI Grievance Redressal Portal (IGMS) – For regulatory intervention.
- Insurance Ombudsman – Independent platform for disputes up to ₹30 lakh.
- Consumer Court under CPA 2019 – For compensation against unfair practices.
Kumar K’s case serves as an eye-opener that policyholders must exercise their rights to ensure transparency.
FAQs – Generali Central Life Insurance Claim Complaint
Q1. What is Kumar K’s complaint against Generali Central Life Insurance?
He was wrongly charged a 20% co-pay instead of 10%, forcing him to pay ₹43,000 extra during his mother’s surgery.
Q2. Which policy was this claim under?
This was a corporate health insurance policy with Generali Central Life Insurance WTW (formerly Liazon).
Q3. What was the claim number?
The claim was registered under 12-FGH-25-3-872777-01.
Q4. How much should he have paid?
As per policy, he should have paid ₹33,466 (10% co-pay).
Q5. How much was he actually charged?
He was charged ₹76,000 (20% co-pay).
Q6. What was the financial difference?
The wrong deduction led to an overcharge of ₹43,000.
Q7. Did the insurance company admit their mistake?
Yes, but only after Kumar K raised the issue multiple times.
Q8. Was a refund offered?
Yes, the company agreed to refund within 4–5 working days.
Q9. Why is this case alarming for other policyholders?
Because such errors may go unnoticed by others, leading to silent financial losses.
Q10. What should policyholders always check during hospital discharge?
- Hospital bill vs. Insurance approval letter
- Deduction percentage (co-pay, sub-limits)
- Non-medical expenses exclusions
Q11. Can insurance companies make such errors?
Yes, but as per IRDAI rules, insurers are accountable for accuracy in settlement.
Q12. What does IRDAI say about co-pay deductions?
Insurers must strictly follow the policy wordings agreed with the customer.
Q13. What rights do consumers have in case of overcharging?
They can demand refunds, interest, and compensation for harassment under CPA 2019.
Q14. How can one escalate a claim dispute?
Through IRDAI IGMS portal, Insurance Ombudsman, or Consumer Court.
Q15. What role does the employer play in group policies?
Employers must ensure that insurers handle claims fairly for their employees.
Q16. How common are such co-pay errors?
While rare, such cases highlight negligence in claim processing systems.
Q17. Can hospitals also be responsible for billing mismatches?
Yes, sometimes hospital desk errors compound insurance miscalculations.
Q18. What is the best way to safeguard against such issues?
Always cross-verify documents and keep written communication with insurers.
Q19. Can consumers claim interest on delayed refunds?
Yes, if the insurer delays beyond the IRDAI-stipulated timeline.
Q20. What message does Kumar K want to convey?
That consumer vigilance is essential always double-check insurance settlements to avoid losses.
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