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ICICI Lombard - Unjustified Repudiation of Acute Ischaemic Stroke Claim (₹3,79,160.44; Claim #******) Under False Substance Addiction Exclusion (Excl12)

ICICI LombardPC-2026-02839Insurance ClaimsAnonymous ·
ICICI Lombard ICICI Lombard Digital Sanjeev Mantri An Unjustified Health Insurance Claim Rejection During a Medical Emergency – Seeking Accountability from ICICI Lombardn I am sharing my experience publicly in the hope of receiving a fair review and resolution from ICICI Lombard General Insurance Company Limited. I was hospitalised at Max Super Speciality Hospital, Patparganj, from 4 September to 9 September 2026 after suffering an acute ischaemic stroke. I required emergency treatment, including IV thrombolysis, ICU monitoring and continued medical care. However, my health insurance claim of ₹3,79,160.44 has been repudiated under Exclusion Excl12, relating to alcoholism, drug or substance abuse, or addictive conditions and their consequences. My concern is straightforward: My hospitalisation was for an acute ischaemic stroke, not treatment for alcohol or substance addiction. The medical records available to me do not document an addiction diagnosis or establish a causal connection between substance abuse and my stroke. My investigations revealed significantly elevated homocysteine and Vitamin B12 deficiency, which warrant medical consideration in assessing stroke risk. I have requested the insurer to provide the specific medical evidence and policy provisions supporting this repudiation, along with a fair reconsideration of my claim. I purchased health insurance to protect my family against precisely these kinds of medical emergencies. Instead, I am facing substantial financial hardship after arranging funds for hospital expenses, including borrowing money at high interest. I respectfully call upon ICICI Lombard's Grievance Redressal Officer, Health Claims leadership and senior management to review this matter fairly, transparently and on the basis of the actual medical records and applicable policy terms. Claim Details: Insurer: ICICI Lombard General InsurancenClaim No.: 226017361200nPolicy No.: 100079022400nPolicy: Elevate Health InsurancenHospital: Max Super Speciality Hospital, Patparganj, New DelhinClaim Amount: ₹3,79,160.44nReason for Repudiation: Exclusion Excl12n I am not seeking any special favour. I am seeking a fair assessment of my claim and the benefits for which I purchased this policy. I request ICICI Lombard to reconsider the repudiation, provide a reasoned written response, and settle the admissible claim amount in accordance with the policy terms and applicable regulations. I hope the company's leadership will intervene and help resolve this matter without requiring further escalation to the appropriate grievance redressal authorities. ICICI Lombard — please review this case on its merits and help restore my faith in health insurance. #ICICILombard #HealthInsurance #InsuranceClaim #ClaimRejection #CustomerRights #IRDAI #InsuranceOmbudsman #ConsumerRights #HealthInsuranceClaim

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  1. Case filed

    System · 23 Oct 2026, 5:58 pm

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