Complaint regarding Max Bupa refusing claim – India Consumer Forum
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Complaint regarding Max Bupa refusing claim

My dad purchased an accidental insurance policy after undergoing all health check ups as per Max Bupa’s T&C holding policy. After a couple of months, he had an accident where it was a hit & run case with FIR duly signed & Evidences submitted. He was admitted in Kamineni hospitals by public from the spot & next day initial request for claim was approved by max bupa. Therefore after 12 days he was ok to be discharged & final bill was sent to max bupa. We were needed to wait for an extra day due to outage in max bupa’s pre auth. Systems to response. we did & had no response until the next day. The next morning we got to know claim was rejected by max bupa. Upon asking the reason for my Dad’s claim rejected, they mentioned non disclosure of following scenarios: Hypertension since 18 months, undergone Polio surgery 40 years ago & hip Surgery. However all this is fake & my Dad has no such Medical records. Only 1 major accidental case a Surgery on Left thigh (above knee) was notified, which was Shown as Hip Surgery by the investigating officer when I was in ICU. It’s fraud done by them with all fake reasons despite we have proof of all History Medical records. Finally we have been asked to pay bills & ask for reimbursement without any assurance of reimbursement. I do not understand what is the relationship between these fake statements & my accidental coverage. Please look into the matter & help me.

Govindram Soni
Hyderabad 500012, Telangana

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