Preeti Chobey, who identifies herself as a former journalist on social media platform X, stirred up a storm after she wrote of her unsavoury experience over claim rejection with a private health insurance company.
Chobey alleged she was admitted to Medanta Hospital (in Haryana’s Gurgaon (unverified)) due to “sudden unconsciousness” and was counting on her HDFC ERGO health insurance to cover the hospital expenses. But she was shocked when her claim was rejected, as the insurance company cited that her unconsciousness arising out of tension cannot be a valid ground for an insurance claim.
“I was admitted in Medanta due to sudden unconsciousness and I had @HDFCERGOGIC insurance, which covers Medanta. They referred me to the ICU heart later on. HDFC denied my claim, stating it happened due to tension. I trusted my insurance, and now they left me with no choice,” Chobey wrote in her post.
Her outcry stirred up an online storm with netizens joining the outcry, with her post amassing over 1.4 million views since she posted on social media on April 21, 2024. Concerned netizens expressed solidarity with Chobey, with many others raising their own grievances against health insurers. One user wrote, “I have @HDFCERGOGIC too. This is very scary,” to which Preeti Chobey, wrote, “cancel it then, they are scammers”.
As the post went viral, HDFC ERGO reached out to Chobey on X, saying, “Hello Preeti, this is certainly not the experience we want you to have, and I deeply regret any inconvenience caused in the process. I request you to share your policy number and contact details privately so I can re-escalate it to the relevant department. Wish you a good health.” Many users noted that as health insurance premiums are skyrocketing, it is shocking to see insurance companies doing this to their customers.
India has recorded the highest medical inflation rates in Asia at 14 per cent, which has taken health insurance premiums to new highs lately.
This alleged rejection has shed light on health insurance claim rejection issues. Note that disclosure of pre-existing diseases (PEDs) is essential for easy claims settlement. Also, high blood pressure, diabetes, asthma, hypertension can be counted by health insurers as pre-existing diseases (PEDs). But in case of Chobey, it is not evident if it was a sudden occurrence of tension or if she was suffering from hypertension since long and if it was earlier disclosed to the health insurer.
However, it should also be noted that many district consumer forums and judgements from consumer redressal commissions have reiterated that a cardiac patient cannot be denied health insurance even if he/she has not mentioned hypertension and diabetes as PEDs.
“We have taken the view that in a large number of cases, diseases like hypertension and diabetes are so common and are always controllable... (so) unless a patient undergoes a long treatment, including hospitalisation and undergoes operation in the near proximity of taking the policy (sic), (s/he) cannot be accused of concealment of facts,” the Mumbai district consumer forum said in a 2010 judgment. So there is enough scope for consumers to fight the case legally if their claims were rejected on grounds of you having “tension”.
Most importantly, customers should scrutinise how an insurer has been settling claims in the past before choosing any health insurer. One should also check how quickly the insurer is processing claims and the number of claims settled.
According to data from the Insurance Regulatory and Development Authority of India (Irdai), in 2022-23, insurers settled about 86 per cent of the total number of claims registered in their books till March 31, 2023. The insurance companies have repudiated about 8 per cent of them and six per cent of the total were pending settlement. There are many standalone health insurers with claim settlement ratio of 99-100 per cent. But interestingly, the incurred claim ratio of almost all standalone health insurers have dipped in comparison to previous years.
As a buyer of an insurance policy, one should take care to furnish complete information on claim forms, disclose all PEDs, and read all exclusion clauses that might be buried under the fine print, in order to improve their claim settlement chances.
