Om Singla alleges that Aditya Birla Health Insurance rejected his sister’s hospitalisation claim despite severe liver swelling, jaundice, typhoid, and hepatitis A. Complaint filed on Choice4Voice.com highlights serious consumer grievances against the insurer.
Complaint Summary : Aditya Birla Health Insurance Claim Rejection – Om Singla’s Complaint on Sister’s Hospitalisation
| Details | Information |
|---|---|
| Complainant Name | Om Singla |
| Not disclosed | |
| Company/Brand | Aditya Birla Health Insurance Company Limited |
| Complaint Type | Health Insurance Claim Rejection |
| Product/Service | Health Insurance Policy |
| Policy Number | 31-24-0292210-08 |
| Issue Description | Despite hospitalisation for severe liver swelling, jaundice, typhoid, and hepatitis A, Aditya Birla Health Insurance allegedly termed the illness as a “minor issue treatable at home” and denied claim approval. |
| Date of Incident | September 2025 |
| Company’s Response | Claim rejected, citing medical assessment |
| Additional Comments | The complainant states that the family has been a loyal customer for 10 years, regularly paying premiums, yet their genuine claim was denied. |
Original LinkedIn Post: Click Here
Full Write-Up
Background of the Complaint
Om Singla, a private banking professional with ICICI Bank, raised a grave consumer grievance against Aditya Birla Health Insurance Company Limited after his sister’s critical hospitalisation was dismissed as a “minor problem” by the insurer’s medical assessment team.
According to Mr. Singla’s LinkedIn post, his sister was hospitalised after suffering from severe liver swelling, jaundice, typhoid, and hepatitis A. Despite her critical condition, the insurer allegedly refused to approve the hospitalisation claim, suggesting that the illness could be managed at home with “paracetamol.”
Medical Condition of the Patient
The complainant shared details of his sister’s medical condition:
- Liver Function Markers: Elevated to 4000 (normal range 5–45).
- Continuous Symptoms: Vomiting for 3 days, inability to consume food, fainting due to weakness.
- Diagnosed Illnesses:
- Liver swelling
- Jaundice
- Typhoid
- Hepatitis A
- Treatment Provided: Hospitalisation, glucose, antibiotics, and continuous medical supervision.
Despite these medical facts, Aditya Birla Health Insurance allegedly concluded that hospitalisation was “unnecessary.”
Customer Relationship with Aditya Birla Health Insurance
Mr. Singla highlighted that his family has been a loyal customer for over 10 years, regularly paying premiums without fail. Over the years, several other insurance agents approached them with competitive offers, but the family chose to stay with Aditya Birla Health Insurance because of the brand’s reputation and promised reliability.
However, this experience left them feeling betrayed, as their decade-long trust was disregarded when they needed financial support the most.
Financial and Emotional Stress
The family is now struggling with both emotional trauma and financial burden. As medical bills mount, the insurance company’s denial has caused immense distress.
Mr. Singla writes:
“We are not asking for charity. We are asking for what we paid for over the last decade.”
This situation highlights a broader concern about consumer trust in health insurance companies, especially when claims are denied despite clear medical necessity.
Industry Implications
Health insurance is built on trust. Customers pay premiums for years, expecting insurers to provide financial support during medical crises. If claims for severe conditions like hepatitis, jaundice, and liver swelling are rejected, it raises serious questions about the credibility of claim assessment procedures.
Such incidents can discourage individuals from purchasing health insurance and erode faith in the industry. Regulatory bodies like the Insurance Regulatory and Development Authority of India (IRDAI) need to ensure stricter monitoring and fair claim settlement practices.
Choice4Voice.com’s Stand
At Choice4Voice.com, we strongly believe that every consumer has the right to fair treatment. When companies deny services without valid justification, it is our responsibility to amplify the consumer’s voice and demand accountability.
We urge Aditya Birla Health Insurance Company Limited to:
- Immediately review Mr. Singla’s claim.
- Provide a transparent medical justification for their decision.
- Compensate the customer for financial and emotional hardship if the denial is found to be unjustified.
Frequently Asked Questions (FAQs)
Q1: What is the main complaint against Aditya Birla Health Insurance?
A1: The insurer allegedly rejected a hospitalisation claim for a patient suffering from liver swelling, jaundice, typhoid, and hepatitis A, calling it a “minor issue treatable at home.”
Q2: Who raised this complaint?
A2: The complaint was raised by Om Singla, a banking professional, regarding his sister’s hospitalisation.
Q3: What policy number was mentioned in the complaint?
A3: The policy number shared by the complainant is 31-24-0292210-08.
Q4: How long has the family been a customer of Aditya Birla Health Insurance?
A4: The family has been a loyal customer for over 10 years, consistently paying premiums.
Q5: What were the patient’s medical conditions?
A5: Severe liver swelling, jaundice, typhoid, and hepatitis A with liver function markers elevated to 4000.
Q6: Why was the claim rejected?
A6: According to the complainant, the insurer’s medical team concluded that the condition could be treated at home with basic medicines, which the family strongly disputes.
Q7: What treatment was given in the hospital?
A7: The patient received glucose, antibiotics, and continuous medical care, as per doctors’ advice.
Q8: Is hospitalisation required for hepatitis A and jaundice?
A8: Yes, in severe cases with complications, hospitalisation is medically necessary.
Q9: Can insurance companies deny hospitalisation claims?
A9: Yes, but only if the claim is fraudulent or the treatment is unnecessary. Denials in genuine cases are unethical and may be challenged.
Q10: What can customers do if their claim is unfairly rejected?
A10: Customers can escalate the matter to the Grievance Redressal Officer, and if unresolved, to the IRDAI or the Insurance Ombudsman.
Q11: What role does IRDAI play in such cases?
A11: IRDAI regulates insurance companies and ensures consumer protection. Complaints can be escalated through the IGMS portal.
Q12: How common are health insurance claim rejections in India?
A12: Claim rejections do occur, often due to technicalities, documentation issues, or disputed medical assessments.
Q13: What should customers keep in mind while buying health insurance?
A13: Read policy exclusions, keep all medical documents, and confirm hospitalisation coverage.
Q14: Can a claim be reopened once rejected?
A14: Yes, customers can appeal with additional medical evidence.
Q15: What financial risks arise from claim rejection?
A15: Families may face huge out-of-pocket medical bills despite years of paying premiums.
Q16: Does hepatitis A require insurance coverage?
A16: Yes, unless specifically excluded, hospitalisation for infectious diseases like hepatitis A is covered under most policies.
Q17: How can Choice4Voice.com help in such cases?
A17: By publishing verified complaints, we create pressure on companies to respond and resolve consumer grievances.
Q18: What are the emotional impacts of claim rejection?
A18: Stress, anxiety, and loss of trust in the insurer, especially during critical medical emergencies.
Q19: What action should Aditya Birla Health Insurance take?
A19: Review the case fairly, approve the genuine claim, and rebuild customer trust.
Q20: Can this happen to any policyholder?
A20: Yes, any consumer may face claim rejections if insurers adopt unfair practices, which is why awareness and advocacy are important.
If you have faced a similar issue with your insurance company, you can submit your complaint at Choice4Voice.com
