r/InsuranceTroubleIndia

saw a term insurance case recently that made me rethink the whole "fast approval = good insurer" thing

applicant completed medicals for a ₹2cr term plan. one report came outside the insurer's acceptable range

Aditya Birla Sun Life Insurance didn't reject the application. ABSLI postponed it and asked for fresh reports after a few months before taking a new decision

1st reaction was obviously:

• why not just increase the premium and issue it?

but now i'm wondering if postponement is actually the cleaner outcome

at least the insurer is saying there is an unresolved medical point before issuing the policy instead of treating it casually just to complete the sale

things i would ask ABSLI in writing:

• exact reason for postponement
• earliest date to reapply
• which fresh reports will be required
• whether loading or lower cover was considered
• whether this counts as a declined application
• what must be disclosed to another insurer now

my understanding is:

• postponement ≠ rejection
• loading ≠ exclusion
• applying elsewhere doesn’t make this outcome disappear
• future approval is still not guaranteed

the part i found positive was that ABSLI gave a defined underwriting outcome instead of leaving the file on endless "medical review"

would you consider this responsible underwriting or just an insurer avoiding risk?

also, what should the applicant collect before closing the file so there is no confusion six months later?

M28 here, In 2025 I got myself a standalone OPD insurance from star health, I was lucky to get in because some months later only they stopped taking new members and kept it strictly as an (very expensive) add on to existing heath insurance. My first year was a breeze I paid 5k for 25k cover and went through it in 6 months, everything was cashless and was accepted and arranged without much scrutiny like medicines, diagnostic tests and consultations. I felt so good about the policy that enhanced the cover for it to 75k and paid 9k for it on renewal in March 2026.

In April-May around this year I noticed a disturbing detail in the policy that offline reimbursements for medicines were not allowed even though the policy clauses detail a reimbursement process and never mentioned everything has to be compulsorily cashless. Since I planned to keep this policy life long I realised in case of any serious disease like TB or Spine or anything a lot of meds are exclusively sold offline hence it will become useless once I get old and when I actually need a OPD cover, but since this violated my point of sale policy wordings I did a lot of back and forth with customer care on this finally raising it to GRO level but got the same template reply "reimbursement is not available on your policy"

In june I decided to put a complaint to bimabharosa and Ombudsman. And since exactly this point my policy experience has been worse. Basic tasks of policy like uploading consultations prescriptions post bookings are met with very heavy scrutiny (like I receive 3-4 scrutiny calls for 1 line prescriptions), they are now rejecting my regular medicine deliveries giving random and vague reasons which are no where in the policy wordings. On a call a customer care executive admitted that policy wordings on the website are not "updated" and they have an internal policy which is not yet on the website and if I have any issues I raise a customer ticket, which takes weeks to get resolved and is met with same templated responses. Another disturbing issue which happens is that my app tickets go missing or stop showing up on the app randomly so I am unable to track or see any updates in the same

I am so confused about what to do, what are my options? The ombudsman complaint I referred to above is going nowhere, they asked for a bunch of docs on mail but never replied since ~1 month, the complaint number itself is not showing up on their portal

Given how blatant star health has been in violating given policy wording on their website I am not sure what new reason they will give to reject my new claims. What can I do? I don't have resources and time to go to an actual court. Is there someone else who can help?

Planning to port my Star Health policy. Advisor suggested Niva Bupa ReAssure 3.0, ICICI Elevate, Care Supreme and Tata AIG.

We have some pre-existing medical/surgical history, so advisor says 20–30% loading may apply and final approval depends on underwriting.

Before proceeding, what should I specifically clarify with the advisor regarding

Looking for advice from people who have actually ported with PEDs.

My uncle has star health insurance and paying all timely premiums since last 10 years. Yesterday my uncle slipped at home and fractured his Femur bone. I went to show my uncle at Star Health panel hospital where cashless treatment is allowed. Doctor did a regular blood test and x-ray and then forwarded case to PAC (Pre-Anesthetic Checkup) before Surgery to fix the bone . In PAC, all the basic details were noted by doctor before a surgery. Then hospital submitted case for cashless treatment approval to star health after submitting an estimate and other documents.

Star health with 20 minutes rejected the claim by picking a point from PAC where all the basic details mentioned such as no medications, allergy, lifestyle and 'socially consume alcohol' and quoted following:

"Based on the submitted medical records, it has been observed that the insured patient has undergone treatment for a condition resulting from the use of alcohol, drugs, or substance abuse. As per Alcoholism, drug or substance abuse Exclusion Code 12, the policy excludes coverage for any expenses incurred for treatment related to alcoholism, drug or substance abuse, or any addictive condition and its consequences. Therefore, we regret to inform you that the claim is not admissible."

There was nothing to substantiate to this reason in the documentary form such as in the blood test or anything. Now what to do because it is very illogical because the cause of fall is nowhere written as under influence of alcohol. We went ahead for surgery by bearing all the cost from the pocket. Please advise what should i do?

Edit: i have 2 choices either i get remark from PAC doctor that he wrote down 'social' in alcohol column due to mis communication and state there is no alcohol history.

Or i get remark from ortho doctor who did surgery that there is no alcohol sign in patient and in his blood reports which may relate to this injury. (This time we may get claim but in future, there are chances if we go for any heart, liver ir other related issue, They will outrightly deny the claim stating this 'social' remark in PAC report.

Please guide with which option i should go?

https://preview.redd.it/4l127cq2j2kh1.png?width=996&format=png&auto=webp&s=97a319b37998124c307ad3fa96cc2d987a790ce5

Hi, I am 26 (F), Single, I am finally taking health insurance.

I have one retiring and one retired parent (who's a heart patient), their insurance also needs to be set in place - however since I learnt it doesn't make sense premium amount wise to club it with mine - i am focusing on getting my health insurance first. (please correct me if i'm wrong here)

____

After my due research with all the features:

For Private, i am considering either

HDFC Ergo Optima Secure Plus (via Ditto) -or-

Care Supreme (via Ditto)

For PSU, i am considering

A policy from New India Assurance (not sure which policy yet)

____

Here are the pointers making it difficult for me + a few doubts:

One one hand, i feel it's better to have 100% cashless coverage or support for non-network without any co-payment clauses with a private insurer like HDFC or Care.

But on the other, i feel the premiums and the future possibility of them hiking the premiums by 25% or 50% seems ridiculous (i saw horrific reddit threads where the premiums sky rocket each year whereas for public sector it's more predictable and stable). Not to mention nobody actually knows what the CSR is based on. Should i be okay with the co-payment and room rent limit clauses in case, god forbid, i end up with a medical emergency? is taking this risk better than paying the ridiculous premium hikes in your opinon?

should i even keep paying extremely high premiums each year for private insurers based on possible worst case scenarios? or is it okay to cover a moderate amount of risk with a public sector insurer considering steady premium and higher reliance on claim settlement even if it's a lot of paperwork?

If in case i take HDFC Ergo for 10L coverage, and get the no-claim bonus for 5 years making my Total Sum Insured 50L, and then i decide to port to a PSU insurer will i get the full 50L transferred? or only the base sum insured of 10L?

Please let me know if i should be considering anything other than HDFC Ergo, Care, New India Assurance.

(so overwhelmed with this whole process, my first health insurance)

I am a 34-year-old male looking for term insurance with coverage until age 70. I prefer pure term insurance and I’m comparing:
ICICI Pru iProtect Smart: Pay till 70 – ₹18,493/year with WOP rider
LIC Digi Term: Pay till 70 – ₹16,632/year without rider
ICICI Pru iProtect Smart: Pay till 60 – ₹19,741/year with WOP
LIC: Pay till 60 – ₹20,915/year without rider
My main questions:
Which is better for an easy and hassle-free death claim for the nominee — LIC or ICICI Prudential?
Is WOP worth paying ~₹900 extra per year?
Is it better to pay till 60 or 70 for a policy covering till 70?
Which of these policies would you personally choose and why?

Finally getting a bike! It's N160, ordered from Amazon. Just paid money for the RTO in dealership. But I want to get the insurance done through Policy bazaar.
When I am trying to set up the IDV, Policy Bazaar is allowing the max limit till 1.72 Lakhs. Remind you, the bike's Ex-showroom price is 1.31 Lakhs.

More over the insurance plan I'm interested in is from United India Insurance(it's the cheapest). If I manually set the IDV to 1.31 Lakhs, I'm getting the 1.31 Lakhs IDV for 8.5k(before tax) insurance premium. But if I set the IDV to 1.39 to 1.72 lakhs(the maximum limit), i am getting IDV of 1.39 Lakhs for the ALMOST THE SAME amount of insurance premium, i.e 8.5k(before tax).
What should i do gang? Set the IDV to the Ex-showroom price(1.31 L) or get the maximum IDV(1.39 L) out of the policy?

Any help would be appreciated from someone with experience as I'm a complete newbie

IDV at the original Ex-showroom price

If I set a higher IDV

When I was admitted to the hospital, they gave me a deluxe room because there were no single rooms available.

They promised to charge me the same as a single AC room. However, my final bill shows the room as deluxe, and I’m being charged according to single AC itself.

I got a certificate from the hospital explaining the room assignment and gave it to the TPA team. Despite this, my claim was settled with incorrect deductions because they treated it as if I chose a higher room.

No response from them regarding this concern even after raising all grievances.

I need help with this issue.

Hi everyone,
My dad was rushed to the ER for acute breathlessness and severe respiratory distress. The initial medical finding was acute pneumonia. Later, his RT-PCR test confirmed H1N1 Viral Pneumonia. Doctors are also currently evaluating a secondary suspicion of ILD (chest CT is pending).
When he was brought into the ER, my dad honestly mentioned to the triage doctors that he is a chronic smoker, and the doctors wrote "chronic smoker" in the initial case sheet history.
Here is where the issue begins:
Policy History: This is the 9th continuous year of his health insurance policy. However, he had not declared himself as a smoker when the policy was initially taken 8+ years ago.

The Agent/Insurance Manager Stance: The insurance manager/agent is warning us that any case mentioning "smoking" gets straight-away denied. They claimed the company will reject the claim, tag him as a smoker in their records, and use it to deny all future claims too.

Hospital TPA Stance: The hospital TPA sent the ER case sheets (including the smoking note) to the insurance company for pre-auth. They are refusing to guarantee cashless pre-authorization, advising us that we may need to pay cash upfront and apply for reimbursement later.

From what I understand, an emergency ER admission for acute H1N1 viral pneumonia shouldn't be rejected just because a patient smokes, especially since this policy is in its 9th year and should be protected under IRDAI’s Moratorium Period rule (which bars non-disclosure rejections after 5 to 8 continuous years).
Despite this, the threats from the agent and the TPA's hesitation are making our family really anxious while my dad is still in the hospital.
I would really appreciate advice on:
Has anyone faced a pre-auth rejection due to "smoking notes" written by ER doctors for an acute viral/infectious illness?

How strongly does the IRDAI Moratorium Period hold up if the insurer tries to issue a non-disclosure query?

If cashless pre-auth gets denied and we have to go the reimbursement route, what specific steps/doctor notes should I collect before discharge to make sure our reimbursement file doesn't get stuck?

Thanks in advance for your help!

Hi i am renewing my policy with Aditya Birla 2 questions I have regards to porting and PED.

Porting: my agent told me as I have undergone a surgery on my left knee if I port they will be a permanent exclusion on my left knee as insurer expects some problem or surgery on that knee.

Renewal: my agent saying that you can renew with Aditya Birla is the best option and no need to disclose PED surgery as it took place after policy inception but I want to be cautious as many claims are being rejected nowadays saying non disclosure of PED.

Hello, I am from the Philippines. My mother (single) was employed with the said company after she passed. I was told there is a insurance death claim I can receive. I have submitted all requirements asked on April this year. However, i keep following up regarding the status and was told my Ph HR that it is still under review in IN HR since she was single and the claimants is the child instead of a spouse. Any advice on what steps to take?

Hi guys, I have a health insurance, hdfc ergo. In my last claim in 2025 there was some amount they didn't give saying "prolonged stay not justified" so i filed a complaint and has a hearing with insurance Ombudsman.

My policy expires in 4 days. I remember checking the renew insurance web page and it was loading correctly. But i waited until ombudsman hearing to renew.

After ombudsman hearing and some days past that i tried to renew the policy but now I'm unable to renew, it says that the specific policy has changed and i have to call customer executive to renew the policy.

When i called the executive he said i will get a special link in 48hrs through which I can pay. Its been 24 hrs now and still i didn't get any link. Could it be possible that after ombudsman hearing they don't want to renew my policy? Or even if they allow me, would they change policy wording only for me? Or increase the premium?

Hi please let me know if someone take above policy i need a quick help, Plan brief :

8 year premium, 1.5 lakh to be pay per year upto 8year,

Then after maturity, they will give monthly survival benefits like 10k+ per month like...upto 10 years from the maturity year.

so i have been doing some research on health insurance for my family of 4 (2 adult 38m and 31f, 2kids 5yr and 5months)

digit- plan - double wallet - 10L base + 10L restore- premium 17k/yr

acko- plan - platinum lite - 25L base - premium 21k/yr

icici- plan - elevate - 15L base + unlimited restore - premium 25k/yr

im more inclined towards digit but not sure if they service is hassle free, or should i go with icici as its more trusted and reliable.

any suggestions/advice is highly appreciated. Thanks in advance

Hello everyone,

I’m a 23-year-old male and currently unemployed. About two years ago, during my first job, I had a pretty unfortunate experience with health insurance.

I was diagnosed with dengue and was insured with Star Health at the time. My claim was rejected on the grounds that my platelet count needed to be below 50,000 for hospitalization to be covered.

The doctor actually wrote a detailed note explaining why waiting until my platelet count dropped that low could be dangerous and why hospitalization was medically necessary. Given my height and weight, my doctor specifically highlighted even a platelet count below 1 lakh to be concerning. Despite this, the claim was rejected, and I ended up paying more than ₹50,000 out of pocket.

After that experience, I switched to ICICI Lombard and have been paying the premiums ever since. Thankfully, neither my mother nor I have needed to make a claim in the last two years.

For the two of us, I’m currently paying roughly ₹58,000 every 2 years for a ₹1 crore cover.

A few people in my close circle have suggested that I consider switching to HDFC ERGO or Tata AIG, as they've had better experiences with them compared to ICICI Lombard.

So I wanted to ask people here who have actually dealt with these insurers:

• How has your experience been with ICICI Lombard?
• Would you recommend switching to HDFC ERGO or Tata AIG?
• How have your claim settlement experiences been?
• Is there anything specific I should look at before switching insurers?

I’d really appreciate any advice or experiences, especially from people who have actually made claims with these companies.

Thanks.

Hi please let me know if someone take above policy i need a quick help,

Plan brief :

8 year premium, 1+ lakh to be pay per year upto 8year,

Then after maturity, they will give monthly survival benefits like 10k+ per month like...upto 10 years

I'm researching health insurance in India and I'm confused about whether it's better to:

1. Buy directly from the insurer after comparing policies on platforms like Policybazaar/Ditto, or

2. Buy through an advisory broker like Ditto, which can supposedly help with claims, documentation, hospital coordination, and disputes.

For people with actual experience:

• Did you buy directly or through Ditto/another broker?
• If you used Ditto, did they genuinely help when you made a claim?
• If you bought directly, did you ever regret not having an advisor?
• Which option would you choose today, and why?

I'm currently considering Niva Bupa ReAssure and HDFC ERGO Optima Secure, so experiences with these insurers would be especially useful.

Thanks!