What Happened: A genuine hospitalization claim for an accidental ankle injury was wrongfully rejected by Niva Bupa Health Insurance. Despite clear medical evidence from the treating doctor confirming it was a fresh injury, the insurer dug up a minor, unrelated sprain from a year ago to label it a "pre-existing disease" and shockingly alleged fraud to avoid paying ₹2.13 lakhs.
What Happened: A retired senior citizen's health insurance claim of ₹2.32 lakhs for gastrointestinal bleeding was arbitrarily rejected by HDFC ERGO. Despite initially marking the claim as approved in their system, the insurer retrospectively canceled his validly renewed base policy. The rejection was based entirely on a routine, unrelated cardiac stress test (TMT) observation recorded months prior—an observation the insurer already knew about but chose to ignore until a high-value claim was filed. This case exposes deeply concerning, un-transparent claims practices impacting consumers in India.
