Collection of Key Email Conversations with HDFC ERGO regarding Yearly Health Checkup Claim Repudiation

CC/354/2022 Consumer Court Evidence, Edaakhil A22080005770, 23 March 2023, Key Emails of Complaints with HDFC ERGO.

15 min readApr 26, 2023

from: Customer Service <customerservice@hdfcergo.com>
reply-to: customerservice@hdfcergo.com
to: ratul aich <ratulaich@gmail.com>
date: Nov 17, 2020, 10:18 PM
subject: RE:’Service ID=039–597–637'Re: Your HDFC ERGO HEALTH Optima Restore Individual Policy is due for renewal on 29-Nov-20
mailed-by: hdfcergo.com
signed-by: hdfcergo.com
security: Standard encryption (TLS) Learn more

Thanks & Regards,
Amar Gaur
Customer Experience Management Team

from: Customer Service <customerservice@hdfcergo.com>
reply-to: customerservice@hdfcergo.com
to: ratul aich <ratulaich@gmail.com>
date: Nov 28, 2020, 1:10 PM
subject: RE:’Service ID=039–597–637'Re: Your HDFC ERGO HEALTH Optima Restore Individual Policy is due for renewal on 29-Nov-20
mailed-by: hdfcergo.com
signed-by: hdfcergo.com
security: Standard encryption (TLS) Learn more
: Important according to Google magic.

Dear Mr. Aich
Greetings from HDFC ERGO General Insurance.
A warm welcome to the HDFC ERGO General Family, a brand trusted by 1.5 Cr customers. We’re pleased to announce the merger of HDFC ERGO Health (erstwhile Apollo Munich) with HDFC ERGO General. Our name has changed but not the passion to serve our customers. Assure you of our Best services, as always.
We acknowledge receipt of your below email dated November 27, 2020 regarding your concern regarding the Policy number:-AA01265980 / 2805203553540500000
This is in regards to the concern highlighted from your end , we would further like to inform you that in case you decrease the sum insured to Rs. 5 Lac from this renewal i.e November 2020 in that case below will be the eligibility.
Nov. 2019-Nov 2020 None
Nov. 2020-Nov 2021 2000 Rs. as per the Sum insured of Year Nov 2019-Nov 2020
Nov. 2021-Nov 2022 None
Nov. 2022-Nov 2023 1500 Rs. As per Rs. 5 Lac plan
Nov. 2023-Nov 2024 None
Nov. 2024-Nov 2025 1500 Rs. As per Rs. 5 Lac plan
Further regarding the coverage for 2021–2022 will depend on the no claim status during the year 2020–201 in case the sum insured is decreased to 5 Lac at this renewal. In case no claim made , in that case the coverage would be 5+5 Lac (Base SI + Multiplier Benefit).
The restore benefit would be 5 Lac instead of 10 Lac as mentioned by you , hence the maximum coverage amount can be Rs. 15 Lac (5+5+5 Lac)
Wishing you good health and happiness!

Thanks & Regards,
Amar Gaur
Customer Experience Management Team

from: ratul aich <ratulaich@gmail.com>
to: care@hdfcergo.com
date: Nov 22, 2021, 4:38 PM
subject: Re: ‘Service ID=049–824–811’[EXT] What is the difference between preventive health checkup, comprehensive health checkup and full body health checkup?
mailed-by: gmail.com

Hello,
I’d like to know if the following types of Health Checkup will be reimbursed.
https://www.srlworld.com/srlcare-package/200012457/complete-care/advance-with-smart-health-report
The reimburse amount allocated for this year is 2000/- (individual). I’d request you to check the email dated Nov 17 2020 for clarification.
RE:’Service ID=039–597–637'Re: Your HDFC ERGO HEALTH Optima Restore Individual Policy is due for renewal on 29-Nov-20
I’d request your confirmation on both the above query before proceeding further.

Regards,
Ratul Aich
Principal Consultant UX (User Experience)
https://www.linkedin.com/in/ratulaich

from: ratul aich <ratulaich@gmail.com>
to: care@hdfcergo.com
date: Nov 23, 2021, 1:14 PM
subject: Re: ‘Service ID=049–824–811’[EXT] What is the difference between preventive health checkup, comprehensive health checkup and full body health checkup?
mailed-by: gmail.com

I am looking forward to the resolution of following two query to the earliest. PFB.

Regards,
Ratul Aich
https://www.linkedin.com/in/ratulaich

from: Care@HDFCERGO <care@hdfcergo.com>
reply-to: care@hdfcergo.com
to: ratul aich <ratulaich@gmail.com>
date: Nov 23, 2021, 7:04 PM
subject: RE:’Service ID=049–824–811'[EXT] What is the difference between preventive health checkup, comprehensive health checkup and full body health checkup?
mailed-by: hdfcergo.com
signed-by: hdfcergo.com
security: Standard encryption (TLS) Learn more
: Important mainly because you often read messages with this label.

Dear Mr. Aich
Greetings from HDFC ERGO General Insurance.
With reference to your email dated 23rd November 2021 regarding the coverage of preventive health check up under policy number:-2805203553540501000
We wish to inform you that we have already forwarded the service request 49855651 to the respective team.
We are committed to provide you an accurate and timely resolution.
We request you to allow us 24–48 working hrs time to reply to you.

Thanks & Regards
Amardeep Gaur
Customer Experience Management Team

from: Care@HDFCERGO <care@hdfcergo.com>
reply-to: care@hdfcergo.com
to: ratul aich <ratulaich@gmail.com>
date: Nov 25, 2021, 12:12 PM
subject: RE:’Service ID=049–824–811'[EXT] What is the difference between preventive health checkup, comprehensive health checkup and full body health checkup?
mailed-by: hdfcergo.com
signed-by: hdfcergo.com
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: Important mainly because you often read messages with this label.

Dear Ratul,
Greetings from HDFC ERGO General Insurance !!!
With reference to your mail dated 25th November, 2021 policy number :- 2805203553540501.
As per telephonic discussion, we wish to inform you that said test shall be covered under the policy, further the claim will be processed as per policy terms and conditions.

Thanks & Regards,
Radhika Rawat
Customer Experience Management Team

from: Care@HDFCERGO <care@hdfcergo.com>
reply-to: care@hdfcergo.com
to: ratul aich <ratulaich@gmail.com>
date: Nov 26, 2021, 3:45 PM
subject: RE:’Service ID=049–855–651'[EXT] What is the difference between preventive health checkup, comprehensive health checkup and full body health checkup?
mailed-by: hdfcergo.com
signed-by: hdfcergo.com
security: Standard encryption (TLS) Learn more
: Important mainly because you often read messages with this label.

Dear Sir/Madam,
We wish to inform you that, as per the confirmation received from our concerned department health check-up limit for policy number 2805203553540501000 is Rs.1,500/- only.
Also, all mentioned tests will be covered except uric acid and RA factor.
CBC, Urinalysis, Glucose (F), SGOT, SGPT, Bilirubin Total & Direct, Alkaline Phosphatase, LDH, Albumin, Globulin, A:G Ratio, Serum Protein, TSH, Triglycerides, Cholesterol Total, HDL, LDL, VLDL, LDL/HDL Ratio, Cholesterol Total/HDL Ratio, BUN, Creatinine, Total Protein, BUN/Creatinine Ratio, Sodium, Potassium, Chloride, Vitamin D.

Sincerely,
Customer Experience Management Team

from: ratul aich <ratulaich@gmail.com>
to: care@hdfcergo.com
date: Nov 26, 2021, 4:15 PM
subject: Re: ‘Service ID=049–855–651’[EXT] What is the difference between preventive health checkup, comprehensive health checkup and full body health checkup?
mailed-by: gmail.com

I have down grade my policy from 10 lakhs to 5 lakhs. I’ve been given a written confirmation on the following email to utilise 2000/- perior to renew the policy.
I’d request you to check the email dated Nov 17 2020 for clarification.
RE:’Service ID=039–597–637'Re: Your HDFC ERGO HEALTH Optima Restore Individual Policy is due for renewal on 29-Nov-20

Regards,
Ratul Aich
https://www.linkedin.com/in/ratulaich

from: Care@HDFCERGO <care@hdfcergo.com>
reply-to: care@hdfcergo.com
to: ratul aich <ratulaich@gmail.com>
date: Nov 26, 2021, 4:48 PM
subject: RE:’Service ID=049–855–651'[EXT] What is the difference between preventive health checkup, comprehensive health checkup and full body health checkup?
mailed-by: hdfcergo.com
signed-by: hdfcergo.com
security: Standard encryption (TLS) Learn more
: Important mainly because you often read messages with this label.

Dear Sir/Madam,
Thank you for your e-mail dated 26th November 2021.
We wish to inform you that, we have noted your request and forwarded it to our concern team and shall revert to you shortly.

Sincerely,
Customer Experience Management Team

from: ratul aich <ratulaich@gmail.com>
to: care@hdfcergo.com
date: Nov 27, 2021, 7:08 PM
subject: Reimbursement of Health Checkup
mailed-by: gmail.com

Hello,
Policy No : 2805 2035 5354 0501 000
I have downgraded my policy last year. Referring to the following communication, request you to proceed with the reimbursement (2000/-). PFA.
You may also like to take a look at the recent conversations.
RE:’Service ID=049–824–811'[EXT] What is the difference between preventive health checkup, comprehensive health checkup and full body health checkup?
Re: ‘Service ID=039–597–637’Re: Your HDFC ERGO HEALTH Optima Restore Individual Policy is due for renewal on 29-Nov-20
RE:’Service ID=049–954–562' [EXT] Re: Re: Your HDFC ERGO HEALTH Optima Restore Individual Policy is due for renewal on 29-Nov-20
RE:’Service ID=049–855–651' [EXT] What is the difference between preventive health checkup, comprehensive health checkup and full body health checkup?
Please the the following communication. PFB

Regards,
Ratul Aich
Principal Consultant UX (User Experience)
https://www.linkedin.com/in/ratulaich

— — — — — Forwarded message — — — — -

From: Customer Service <customerservice@hdfcergo.com>
Date: Sat, Nov 28, 2020 at 1:10 PM
Subject: RE:’Service ID=039–597–637'Re: Your HDFC ERGO HEALTH Optima Restore Individual Policy is due for renewal on 29-Nov-20
To: ratul aich <ratulaich@gmail.com>

Thanks & Regards,
Amar Gaur
Customer Experience Management Team

from: ratul aich <ratulaich@gmail.com>
to: care@hdfcergo.com
date: Nov 27, 2021, 7:10 PM
subject: Re: Reimbursement of Health Checkup
mailed-by: gmail.com

Password to open the pdf is RATU

Regards,
Ratul Aich
Principal Consultant UX (User Experience)
https://www.linkedin.com/in/ratulaich

from: Care@HDFCERGO <care@hdfcergo.com>
reply-to: care@hdfcergo.com
to: ratul aich <ratulaich@gmail.com>
date: Dec 4, 2021, 3:05 PM
subject: RE:’Service ID=049–855–651'[EXT] What is the difference between preventive health checkup, comprehensive health checkup and full body health checkup?
mailed-by: hdfcergo.com
signed-by: hdfcergo.com
security: Standard encryption (TLS) Learn more
: Important mainly because it was sent directly to you.

Dear Sir/Ma’am,
Greetings from HDFC Ergo General Insurance!!!
With reference to your email for policy no 2805203553540501.
As per the follow-up taken with the concerned team in regards to the said policy, we would like to inform you that you are eligible for 2000/- against health check up benefit.
Further, You can visit our network diagnostic center and avail your health check up facility. Please click on the below link to know the network diagnostic center.
https://www.hdfcergo.com/locators/dc-cashless-hospitals-network

Warm Regards,
Sandeep Mathur
Customer Experience Management

from: HDFC ERGO General Insurance <hdfcergo.service@hdfcergo.com>
reply-to: no-reply@hdfcergo.com
to: RATULAICH@gmail.com
date: Dec 9, 2021, 3:23 PM
subject: HDFC ERGO — Reimbursement Claim Denied-RR-FC21–12734614
mailed-by: hdfcergo.com
signed-by: hdfcergo.com
security: Standard encryption (TLS) Learn more
: Important mainly because it was sent directly to you.

Dear Customer,
Patient Name : RATUL AICH
2805203553540501
HDFC ERGO ID : ER2013558151–01E
CCN No : RR-FC21–12734614
Hospital Name : srl diagnostics
Hospitalization Period : From 27/11/2021 to 27/11/2021
With reference to the reimbursement claim RR-FC21–12734614 of above mentioned patient, we have scrutinized the same with respect to policy terms & conditions. We regret to inform you that we are unable to sanction the cashless benefit for the said hospitalization due to following reasons:
The submitted claim is for health check-up benefit and the criteria defined for this benefit in the policy is not fulfilled. Hence we regret to inform you that your claim is repudiated.

Regards,
Team — Health Claim Services

from: Grievance Cell <grievance@hdfcergo.com>
reply-to: grievance@hdfcergo.com
to: ratul aich <ratulaich@gmail.com>
date: Dec 28, 2021, 2:53 PM
subject: RE:’Service ID=050–667–170'[EXT] Fwd: Re: Your HDFC ERGO HEALTH Optima Restore Individual Policy is due for renewal on 29-Nov-20
mailed-by: hdfcergo.com
signed-by: hdfcergo.com
security: Standard encryption (TLS) Learn more

Dear Sir,
Thank you for your e-mail dated December 26th, 2021.
At the outset, we sincerely regret the inconvenience that has been cause to you in this regards to claim number RR-FC21–12734614.
We would like to inform you that your health check up reimbursement claim rejection is justified as your date of inception is 30/11/2019 however bills provided are dated 27/11/2021.
Hence as per policy terms and conditions, health check up is payable on completion of 2 years.

Sincerely,
Heenal Maru
Grievance Redressal Team

from: Grievance Cell <grievance@hdfcergo.com>
reply-to: grievance@hdfcergo.com
to: ratul aich <ratulaich@gmail.com>
date: Dec 28, 2021, 3:16 PM
subject: RE:’Service ID=050–667–170'[EXT] Fwd: Re: Your HDFC ERGO HEALTH Optima Restore Individual Policy is due for renewal on 29-Nov-20
mailed-by: hdfcergo.com
signed-by: hdfcergo.com
security: Standard encryption (TLS) Learn more

Dear Sir,
Thank you for your e-mail dated December 28th, 2021.
At the outset, we sincerely regret the inconvenience that has been cause to you in this regards to claim number RR-FC21–1273461.
We would like to inform you that we at HDFC ERGO provide only preventive health checkup to our customers and there is nothing as comprehensive and full body health checkup which is been given.
Also the approval mail itself states that you are not eligible for preventive health checkup in the year Nov 2021- Nov 2022.

Sincerely,
Heenal Maru
Grievance Redressal Team

from: Grievance Cell <grievance@hdfcergo.com>
reply-to: grievance@hdfcergo.com
to: ratul aich <ratulaich@gmail.com>
date: Dec 29, 2021, 10:09 PM
subject: RE:’Service ID=050–667–170'[EXT] Fwd: Re: Your HDFC ERGO HEALTH Optima Restore Individual Policy is due for renewal on 29-Nov-20
mailed-by: hdfcergo.com
signed-by: hdfcergo.com
security: Standard encryption (TLS) Learn more

Dear Mr.Ratul,
This is with reference to your email dated December 28,2021 regarding policy number 2805203553540501.
We have re-verified your request on the basis of the details provided by you.After reviewing the details,we would to inform you that,policy is Optima Restore Individual and Sum insured is 5 lakhs,as per policy terms and conditions upto a maximum of Rs1,500 /- per insured person,only once at the end of a block of every continuous 2 Policy Years.
Hence deduction is justified as Policy inception date is since 30/11/2019 as per company underwriting guidelines.
Assuring you of our best services at all times.

Regards,
Team HDFC ERGO

from: Grievance Cell <grievance@hdfcergo.com>
reply-to: grievance@hdfcergo.com
to: ratul aich <ratulaich@gmail.com>
date: Dec 31, 2021, 5:03 PM
subject: RE:’Service ID=050–667–170'[EXT] Fwd: Re: Your HDFC ERGO HEALTH Optima Restore Individual Policy is due for renewal on 29-Nov-20
mailed-by: hdfcergo.com
signed-by: hdfcergo.com
security: Standard encryption (TLS) Learn more

Dear Mr.Ratul,
This is with reference to your email dated December 29,2021 regarding policy number 2805203553540501.
We have re-verified your request on the basis of the details provided by you.
After reviewing the details, we would to inform you that, policy is Optima Restore Individual and Sum insured is 5 lakhs, as per policy terms and conditions up to a maximum of Rs1,500 /- per insured person, only once at the end of a block of every continuous 2 Policy Years.
Hence deduction is justified as Policy inception date is since 30/11/2019 as per company underwriting guidelines.
However, in case you are not satisfied with our decision, you may approach the nearest Insurance Ombudsman for resolution of your grievance. You can locate nearest OMBUDSMAN contact details according to your address by accessing following link -https://www.hdfcergo.com/grievance/Insurance_Ombudsman_Centers.html.

Regards,
Heenal Maru
Team HDFC ERGO

from: Grievance Cell <grievance@hdfcergo.com>
reply-to: grievance@hdfcergo.com
to: ratul aich <ratulaich@gmail.com>
date: Dec 31, 2021, 5:32 PM
subject: RE:’Service ID=050–667–170'[EXT] Fwd: Re: Your HDFC ERGO HEALTH Optima Restore Individual Policy is due for renewal on 29-Nov-20
mailed-by: hdfcergo.com
signed-by: hdfcergo.com
security: Standard encryption (TLS) Learn more

Dear Sir/Madam,
Greetings from HDFC ERGO General Insurance!
With reference to your below e-mail, we would like to inform you that we have reviewed your case and are constraint to reiterate that the outcome of our review is consistent with our earlier decision.
We regret that we are unable to reconsider your request, hence our decision as communicated to you earlier stands as is.
However, in case you are not satisfied with our decision, you may approach the nearest Insurance Ombudsman for resolution of your grievance. You can locate nearest OMBUDSMAN contact details according to your address by accessing following link -https://www.hdfcergo.com/grievance/Insurance_Ombudsman_Centers.html.

Sincerely,
Heenal Maru
Grievance Redressal Team

from: Grievance Cell <grievance@hdfcergo.com>
reply-to: grievance@hdfcergo.com
to: ratul aich <ratulaich@gmail.com>
date: Jan 20, 2022, 7:46 PM
subject: RE:’Service ID=051–288–573'[EXT] Re: HDFC ERGO — Reimbursement Claim Denied-RR-FC21–12734614
mailed-by: hdfcergo.com
signed-by: hdfcergo.com
security: Standard encryption (TLS) Learn more
: Important because you marked it as important.

Dear Sir/Madam,
Greetings from HDFC Ergo General Insurance!
At the outset, we sincerely apologize for the inconvenience caused to you.
This is with reference to your email regarding claims reconsideration, we would like to state that we have evaluated the case with due diligence and we are constraint to reiterate that the outcome of our review is consistent with our earlier observation / decision on your queries.
In view of above highlighted concern, we would like to inform you that your claim has been repudiated after careful evaluation and scrutiny of reports/medical bills. Followed by thorough investigation under the terms and spirit of the policy.
Hence, we regret to inform you that no fresh ground has been made out for reconsideration of your alleged claim by you affecting our decision.

Sincerely,
Grievance Redressal Team

from: Grievance Cell <grievance@hdfcergo.com>
reply-to: grievance@hdfcergo.com
to: ratul aich <ratulaich@gmail.com>
date: Dec 26, 2022, 11:55 PM
subject: RE:’Service ID=063–583–380' [EXT]Re: Summoning HDFC ERGO by Consumer Forum Barasat N24PGS West Bengal
mailed-by: hdfcergo.com
signed-by: hdfcergo.com
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Dear Mr. Aich,
We understand from your communication below that you have filed a consumer complaint against our company before the Hon’ble consumer commission.
As the matter is sub-judice, we shall respond to all your averments before the said consumer commission through our designated lawyer. We therefore request you to wait for the outcome of the said complaint.

Regards,
Nisha Wagh
Grievance Redressal Team

HDFC ERGO lied to the Insurance Ombudsman (Bimalokpal). Best to my Knowledge legally lying to the Government of India, Sub-judice Administrative/Regulatory body is a perjury/forgery offense.

from: bimalokpal kolkata <bimalokpal.kolkata@cioins.co.in>
to: ratul aich <ratulaich@gmail.com>
date: Jul 29, 2022, 6:21 PM
subject: Re: HDFC ERGO — Reimbursement Claim Denied-RR-FC21–12734614
mailed-by: cioins.co.in
signed-by: cioins.co.in
security: Standard encryption (TLS) Learn more

Dear Sir,
This has reference to your trailing mail regarding the Award issued by the Hon’ble Ombudsman vide Award No. IO/KOL/A/HI/0036/2022–2023 dated 17.05.2022 against your Complaint registered in this office under Complaint No.KOL-H-018–2122–0878.
It may be mentioned that the Award has been issued taking into account the facts & circumstances of the case and submission made by both the parties during the course of hearing and going through the documents on record.
If the decision is not acceptable to you, you are at liberty to approach any other Forum/Court as per Law of the Land against the Respondent Insurer.

Regard,
A.O.
Office of the Insurance Ombudsman
Hindustan Building Annexe, (7th Floor),
4 C.R. Avenue, Kolkata-700 072

On Mon, Jul 25, 2022 at 3:02 PM ratul aich <ratulaich@gmail.com> wrote:
Hello Bimalokpal,

I’m looking for updates about the action taken by Bimalokpal on the Insurer HDFC ERGO for lying to Bimalokpal. Three weeks have passed since the incident has been reported. I’ll be compelled to take appropriate legal action for insincerity if I don’t receive any communication from the Bimalokpal.

Regards,
Ratul Aich
Principal Consultant UX (User Experience)
https://www.linkedin.com/in/ratulaich

On Mon, Jul 4, 2022 at 6:03 AM ratul aich <ratulaich@gmail.com> wrote:

Hello Insurance Ombudsman,
The Insurance Ombudsman is a Central Government Administrative Law Body. Insurance Company lying and misleading the Insurance Ombudsman is a perjury/forgery criminal case that is considered to be harmful to society and the state. Request Ombudsman to register FIR.
HDFC ERGO HEALTH INSURANCE Policy Number 2805203553540501.
Insurance Ombudsman Complaint Number — KOL-H-018–2122–0878.
Insurance Ombudsman Award Number — IO/KOL/A/HI/0036/2022–2023

Fri, Nov 26, 2021 at 4:23 PM
Re: ‘Service ID=039–597–637’Re: Your HDFC ERGO HEALTH Optima Restore Individual Policy is due for renewal on 29-Nov-20

Sun, Dec 26, 2021 at 12:32 AM
Fwd: ‘Service ID=039–597–637’Re: Your HDFC ERGO HEALTH Optima Restore Individual Policy is due for renewal on 29-Nov-20

Please check earlier emails too.

Regards,
Ratul Aich
Principal Consultant UX (User Experience)
https://www.linkedin.com/in/ratulaich

from: inscoun . <inscoun@cioins.co.in>
to: ratulaich@gmail.com
date: Jan 25, 2023, 6:14 PM
subject: Re: HDFC ERGO — Reimbursement Claim Denied-RR-FC21–12734614
mailed-by: cioins.co.in
security: Standard encryption (TLS) Learn more
: Important mainly because you often read messages with this label.

Sir,
This has reference to your trailing mail addressed to Council for Insurance Ombudsmen on the above subject.
In this regard kindly note that, as specified by Office of Insurance Ombudsman( OIO), Kolkata vide their mail dated 29.07.2022, the Award is issued taking into consideration the facts & circumstances of the case & submission made by both the parties during the hearing.
Hence the procedure followed by OIO Kolkata is as per the provision stipulated in Insurance Ombudsman Rules, 2017( amended till date).

Thanks and regards
Assistant Secretary
Office of the Council for Insurance Ombudsmen,
(Formerly Office of the Executive Council of Insurers/
Governing Body of Insurance Council)
3rd Floor, Jeevan Seva Annexe Bldg., S.V. Road,
Santa Cruz (West)
Mumbai — 400 054.
Phone.: 91 22–69038800/69038812
Website www.cioins.co.in

Tweet Thread, Timeline of the Events. (Link)

First in the series is, How effective is complaining to the Insurance Ombudsman and the Insurance Regulatory and Development Authority of India (IRDAI)? (Link)

Previous in the series is, Quasi Judicial Patients, & Victims of Insurance Companies Institutional Exploitation. (Link)

Next in the series is, BRIEF NOTE OF ARGUMENT CC-354–2022. (Link)

Collection of Key Email Conversations with HDFC ERGO regarding Yearly Health Checkup Claim Repudiation

CC/354/2022 Consumer Court Evidence, Edaakhil A22080005770, 23 March 2023, Key Emails of Complaints with HDFC ERGO.

Written by Ratul Aich