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Bad ICICI Lombard Experience
I want to mention on this blog about a bad ICICI Lombard health insurance experience. Our company has a group policy that covers health of all individuals, and we have always had a maternity cover also.
Before my child was born I had our HR executive called up the executive that sold us this insurance and confirmed that maternity was covered, and he said it was. Still not convinced I read through the policy which had it in the "endorsements" section. Assuming that yes, this endorsement is in our policy, we went ahead with the room selection etc. for the hospital.
When my son was born I submitted the form for a "cashless" claim, and the Third Party Adminstrator (TPA) rejected the claim, saying maternity was not covered. I then called up the ICICI Lombard executive who still maintained that it was. Angry with the TPA, I called and gave them a piece of my mind. To their credit they listened to me patiently and told me that the policy did not have the maternity endorsement.
I then paid up at the hospital and a few days later when I reached the office, checked the copy of the policy document. Guess what. The front page is a printed cover that mentions our office name, address and number of employees covered. There's a section for "endorsements" which was empty. Then there was a pre-printed set of terms and conditions which specifically rules out maternity unless endorsement E2 is applicable. Endorsement E2 - the maternity endorsement - is also printed later.
Well, it turns out that "Endorsement E2 is applicable" must be printed on the front page, otherwise the endorsement is not valid. This is weird. If I have a policy document in which the endorsement is present, it is not enough. The fact that the endorsement is VALID should be printed somewhere else? How is anyone supposed to know this? Even in my LIC policy only those endorsements are listed which apply to me! Why can't ICICI Lombard give us a group policy document that contains only those endorsements that apply to us, especially when we pay a ton more of premium?
Of course, their stand is all legal. And it is my stupidity that I did not get a court approval before I went to the hospital. But I think this was a way to trick us, because the document is worded in a way that makes me believe that the endorsement is applicable, but when you try to claim it is not. Further the maternity benefit was there in earlier years, and during renewal they removed it and we were dumb for trusting them. Still, that is a standard trick and now I am smarter, and I hope you are too.
What is inexcusable was ICICI Lombard's procedure to handle the claim. I didn't hear one apology from anyone; everyone we called insisted that the maternity claim was valid and that they would call us back but they never did. And the TPA was actually more helpful than ICICI's executives. Even to the end, there was just a blame game going on at ICICI and then I gave up.
ICICI Lombard executives came to my office yesterday to renew our building insurance. I have cancelled every single insurance we hold with them and am getting quotes from others. It is unlikely that I will ever use their services again.
Before my child was born I had our HR executive called up the executive that sold us this insurance and confirmed that maternity was covered, and he said it was. Still not convinced I read through the policy which had it in the "endorsements" section. Assuming that yes, this endorsement is in our policy, we went ahead with the room selection etc. for the hospital.
When my son was born I submitted the form for a "cashless" claim, and the Third Party Adminstrator (TPA) rejected the claim, saying maternity was not covered. I then called up the ICICI Lombard executive who still maintained that it was. Angry with the TPA, I called and gave them a piece of my mind. To their credit they listened to me patiently and told me that the policy did not have the maternity endorsement.
I then paid up at the hospital and a few days later when I reached the office, checked the copy of the policy document. Guess what. The front page is a printed cover that mentions our office name, address and number of employees covered. There's a section for "endorsements" which was empty. Then there was a pre-printed set of terms and conditions which specifically rules out maternity unless endorsement E2 is applicable. Endorsement E2 - the maternity endorsement - is also printed later.
Well, it turns out that "Endorsement E2 is applicable" must be printed on the front page, otherwise the endorsement is not valid. This is weird. If I have a policy document in which the endorsement is present, it is not enough. The fact that the endorsement is VALID should be printed somewhere else? How is anyone supposed to know this? Even in my LIC policy only those endorsements are listed which apply to me! Why can't ICICI Lombard give us a group policy document that contains only those endorsements that apply to us, especially when we pay a ton more of premium?
Of course, their stand is all legal. And it is my stupidity that I did not get a court approval before I went to the hospital. But I think this was a way to trick us, because the document is worded in a way that makes me believe that the endorsement is applicable, but when you try to claim it is not. Further the maternity benefit was there in earlier years, and during renewal they removed it and we were dumb for trusting them. Still, that is a standard trick and now I am smarter, and I hope you are too.
What is inexcusable was ICICI Lombard's procedure to handle the claim. I didn't hear one apology from anyone; everyone we called insisted that the maternity claim was valid and that they would call us back but they never did. And the TPA was actually more helpful than ICICI's executives. Even to the end, there was just a blame game going on at ICICI and then I gave up.
ICICI Lombard executives came to my office yesterday to renew our building insurance. I have cancelled every single insurance we hold with them and am getting quotes from others. It is unlikely that I will ever use their services again.
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