Insurance companies violating IRDA norms during Covid-19, denying cover to ailing people

Indian Insurance companies, their behaviour with customers with preexisting illness. Incase you are not from India, you might still find this content useful as almost all of these companies are in tie-up with a major international insurer whom you might have your policy with.

Indian Insurance companies, their behaviour with customers with preexisting illness. Incase you are not from India, you might still find this content useful as almost all of these companies are in tie-up with a major international insurer whom you might have your policy with.

Abhishek Muthian, one of the policy holder in insurance company shared his painful experience. Insurance company giving a hard time during the Covid-19 pandemic, that’s even worse.

While sharing his story he said, “I’m suffering from what could be best summarised in simple terms as Bone related diseases, I had a major surgery in July 2018 for ailments which has since been successfully addressed. I’ve been very open about my health condition to raise awareness and to support others facing such ailments.”

“Like many others during this COVID-19 pandemic, I applied for a health insurance top-up plan as my current base plan(subscribed ~5 years ago, much before 2018 surgery) doesn’t have the necessary coverage to compensate for the amount of money private hospitals are charging for COVID-19 treatment.”, he added.

Insurance Regulatory and Development Authority(IRDAI) is Indian government’s regulatory body for insurance and re-insurance industries in India. IRDAI had released several advisories regarding how the health insurance companies should treat customers with preexisting illness.

According to IRDA guideline for Preexisting diseases (PED) the policy issued by the insurer or its reinstatement, or for which medical advice or treatment was recommended by, or received from, a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement.

The PED are excluded during the waiting period(maximum of 4 years). Some PEDs can be permanently excluded from the coverage of the policy when you have preexisting disease while applying for a health insurance

Further Abhishek told, “Since I’m an independent professional, I’m not covered under any corporate health insurance and so I had to apply for a personal health insurance policy. I approached the top health insurance providers in the country, as I believed they would be following government’s guidelines regarding preexisting diseases for health insurance. I was proven wrong.”

In spite of advertising waiting period for PEDs on insurance companies websites, he found out that these insurers are blatantly disregarding the IRDAI guidelines w.r.t PEDs even when they advertise ‘waiting period’ on their websites.

“The following insurers denied me the insurance policy sighting my preexisting illness, even after I pointed out the IRDAI guidelines and raised a complaint with IRDAI’s grievances cell”, Abhishek adds.

The company took extraordinary measures to deny the policy, even after conducting a thorough medical test in which their own doctor certified him as healthy for the policy. Some, didn’t even bother to conduct an underwriter call and denied him for the policy from his stated PEDs in the application after receiving the premium payment.

Abhishek said that, “It is to be noted that, to the best of my knowledge the diseases I suffer from isn’t even permanently excluded according to IRDAI’s guidelines and even if it was the insurers are supposed to exclude it from coverage and provide me with the insurance policy.”

He applied for a health insurance quote on Royal Sundaram General Insurance website, companies agent called and told him about his health condition several times,

He said, “I would be given a policy with waiting period and utmost I would be required to take a medical test to show my current health condition.”

After couple of days received a call from the underwriter doctor from Royal Sundaram, he explained clearly the issue and answered specific Yes/No questions in the call.

He said, “After the call, I remembered that I’m taking treatment for Osteoporosis (Yearly single zoledronic acid inject and monthly Vitamin D tablets); So, I called the doctor again and informed him about my osteoporosis treatment.”

“A day later I was told by another representative of Royal Sundaram that I have to undergo medical tests, which I promptly agreed. My only concern was that I have to travel, visit a hospital when there was increasing number of COVID-19 cases in my city.” Abhishek adds.

After undergoing medical examination by the doctor, Few days later received a mail from Royal Sundaram’s medical team to submit my discharge summary, follow-up medical checkups regarding the surgery. Fellow mailed them discharge summary along with the latest follow-up report in which the doctor has mentioned that his implant status as good.

“After couple of days, I was greeted with this letter in email from Royal Sundaram, in which they mentioned that I have osteoarthritis which fortunately I don’t have and decline due to spinal stenosis surgery done in 2018 which I already mentioned them during the medical examination.”

Abhishek raise a complaint with IRDAI on Royal Sundaram through their grievances cell

Abhishek added, “IRDAI grievances cell has told me that, there’s nothing else they can do about this, they asked me to take Royal Sundaram Insurance to the court mentioning this complaint token number, in spite of repeatedly agreeing to me over the calls that the Insurer is obliged to provide me a with an insurance policy with appropriate waiting period.”

I applied for the health booster top-up insurance policy on the ICICI Lombard website after declaring my preexisting illness and made my payment through their ‘Guest’ login option.I wrote to the customer support of ICICI Lombard attaching the email I received from them after payment, asking why no proposal number was generated for my policy.

After several calls and emails they told me that they were unable to find my payment and asked me to send the bank transaction details, which I did.

Since, ICICI Lombard customer support stopped replying to me(since I sent the bank statement), he told, “I had no other choice but to raise the complaint with IRDAI’s grievances cell via email with CC to ICICI Lombard customer support. Sure enough ICICI Lombard’s service quality team reached out to me and asked for the discharge summary of my surgery. I sent them the discharge summary for the surgery.”

Similar, incident went with HDFC Ergo and Bajaj Allianz.

Furthermore, its been noted that IRDAI’s grievances cell seems to be favouring Insurers and they wave their hands once the Insurer has marked the complaint ‘Attended to’ even if the statement from their end is absolutely false and when my complaint was not resolved.

Muthian said, “I’ve spent hundreds of hours communicating with these insurers and IRDAI grievances cell in asking them to adhere to the IRDAI’s guidelines on preexisting illness in vain, now I have no choice but to take them to the courts.”

“Not just because I might need the insurance to survive a COVID-19 infection or future ailments, Not just because these insurers have caused huge amount of emotional distress, but because now I have a moral responsibility to serve as a voice for those sick and disabled people who have been denied their right by these insurers.” He adds.

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