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Claim Denied by HDFC Ergo

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28 May, 2021 by  Chandan Chakraborty

My daughter admitted on Apollo Gleneagles Hospitals on 08-03-2021 for Endometriosis related operation. Operation took place on 09.03.2021 and she discharged from hospitals on 11.03.2021. During those periods HDFC ERGO was sending queries and finally on 11.03.2021 at 9.41 pm the HDFC Ergo rejected the cashless claim on the following ground," As per the available documents, presenting ailment/procedure for which treatment is sought comes under two years exclusion list of policy terms & condition. i.e. Treatment of Endometriosis, is excluded from the policy if admitted in 2 Years of policy inception date."

I have no objection on the rejection, but only question was that HDFC ERGO should reject it on the date of application, i.e. on 07.03.2021 to 08.03.2021, before date of operation. In that casewe could take another decision. Is this be treated as deficiency in service, negligence of service.

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Health Insurance

1 Answer

Regional Director, Amicus Insurance Broking

The insurance company ought to have been faster in communicating the lack of coverage under the policy. Normally such decision should be conveyed within hours, not days. To that extent, there is a deficiency in service.

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