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ICICI Lombard rejected ₹74,000 cashless surgery claim as "pre-existing" despite 3 claim-free years and a doctor's certificate

ICICI LombardPC-2026-03478Insurance ClaimsAnonymous ·
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I want to bring our extremely disappointing experience with ICICI Lombard General Insurance to the attention of the public and the concerned regulatory authorities. My father developed a lump on his right upper back over the last 10 months. After consulting the doctor, surgery was recommended, and the estimated treatment cost was approx. ₹74,000. We have a health insurance cover of ₹20 LAKHS with ICICI Lombard, which we have been maintaining continuously for more than THREE YEARS. Throughout this entire period, we have regularly paid our premiums and, importantly, have NEVER MADE A SINGLE CLAIM under this policy. We purchased this insurance believing that it would protect our family during medical emergencies and provide financial security when we needed it. However, when we finally approached the company for a cashless claim for my father’s surgery, our experience was shocking. ICICI Lombard rejected our claim, citing ‘Pre-Existing Disease – Not Disclosed’. We were genuinely surprised by this allegation because the lump had developed only during the preceding 10 months. And company has been continuously denying the claim citing its pre-existing. It’s worth mentioning that I have mentioned my mother’s hypertension as pre-existing while taking the policy. Lump is not diabetes, hypertension or any other internal disease which we can hide. It’s a physical lump which can be seen with bare eyes. To clarify the situation, we obtained a medical certificate from the treating doctor, who specifically confirmed the duration of the lump and clarified that it was not a pre-existing disease or swelling. We submitted the medical clarification and approached the company through a formal grievance, requesting them to reconsider their decision. But despite the doctor’s medical certification, ICICI Lombard continued to reject our claim. This is extremely disappointing and raises a very serious question about the accountability of health insurance companies. We have paid premiums for more than three years and have never taken any claim under this policy. And today, when our father needs medical treatment and we are seeking coverage, we are being made to fight for the very protection we have been paying for. Are policyholders expected to keep paying premiums year after year but face repeated rejections when they finally need to use their insurance? We are not asking for any special treatment. We are asking for what we have been paying for all these years: FAIR TREATMENT AND A GENUINE ASSESSMENT OF OUR CLAIM. I sincerely request ICICI Lombard’s senior management and Insurance Regulatory and Development Authority of India to intervene in this matter, look into the repeated rejection and ensure that policyholders are not left helpless when they need medical assistance. If this continues, we will be compelled to pursue appropriate remedies before the Insurance Ombudsman and the Consumer Disputes Redressal Commission. #ICICILombard #IRDAI #ConsumerRight +1

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  1. Case filed

    Filer · 4 Nov 2026, 10:35 am

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