Identification notice: The logo above belongs to IndusInd General Insurance Co. Ltd. and is used here solely to identify the company this documented consumer experience refers to. This page is not affiliated with, endorsed by, or connected to IndusInd General Insurance in any way. Use of this logo constitutes nominative fair use under the Trade Marks Act 1999, Section 30(1) for the purpose of consumer reference only.
We had insurance.
We still paid Rs. 2,38,569
from our pocket.
A first-hand documented account of a maternity insurance cashless claim, the denial that followed, 19 days of no response, and the questions every buyer must ask before choosing a health insurer in India.
All figures are from original hospital bills. This page presents a documented personal experience, not a legal verdict.
Important disclaimer
This website shares a personal and documented consumer experience supported by original hospital bills, medical certificates, lab reports, insurer emails, complaint reference numbers, and grievance filings.
It does not accuse any person or company of a crime. It does not claim to be a court finding or a regulatory order. It is published so other consumers can understand one real claim journey and make an informed decision before buying insurance.
If any factual statement is shown to be incorrect through documentary proof, the author is open to correcting it promptly and without delay.
Key reference numbers on record
Every number below can be cross-referenced with the insurer, hospital, or IRDAI grievance system.
Actual bills paid — not estimates
These figures are taken directly from original hospital bills printed by Motherhood Hospital, Noida. Bill No. IPNDN/26-27/5111 and Bill No. IPNDN/26-27/4886 are on record with the author.
Bill 1 — Mrs. Aishwarya Yadav
Bill 2 — Baby of Aishwarya Yadav
What happened — step by step
Admission and pre-authorization submitted
Mrs. Aishwarya Yadav admitted at Motherhood Hospital, Noida at 36+ weeks of pregnancy. Hospital submitted the cashless pre-authorization request to the insurer.
Query raised on incorrect factual grounds
Insurer issued a query demanding miscarriage records from 2022. No miscarriage occurred in 2022. First miscarriage was 05-December-2023 at St. Stephens Hospital, Delhi. Second was December 2024 at Cloudnine Hospital, Gurugram. Both discharge summaries are on record.
12 calls made. Every call: wait 2 more hours.
Multiple calls made daily. Every call received the same response with no resolution. On Sunday 10 May, the executive stated that senior staff are not available today and nothing can be done.
Contradictory document instructions caused critical delay
One executive asked the family to submit documents directly. After submission, a different executive stated only the hospital could submit. Hospital resubmitted at 4:53 PM. No response received for 24+ hours.
Cashless denied. Rs. 2,38,569 paid in cash.
With no approval and discharge required, total of Rs. 2,38,569 was paid across two bills. The newborn baby in NICU, who was covered from day zero under the policy, was also denied cashless as a cascading consequence.
Complaint officer assigned — never called
Company email confirmed Mr. Swaroop Paul assigned as Complaint Officer with a two-week resolution commitment. As of 26 May 2026, no contact was ever made by him or anyone on the team.
Escalations filed — automated responses only
Complaints filed on IRDAI Bima Bharosa portal. Written escalations sent to Nodal Officer Mr. Vikash Agrawal. Head Grievances also written to. All responses received were automated acknowledgements.
Reimbursement claim registered — 20 days after admission
SMS received from IndusInd General Insurance: "Claim registered: Docs received for claim ref. CL-2600114939 registered. Processing in 15 days." This was 20 days after admission on 07 May and 7 days after documents were first submitted to their representative. The company chose to record receipt from 27 May only, not from the actual submission date of approximately 20 May.
SR 48564400 acknowledged via SMS
Second SMS received: "Claim update: SR 48564400 acknowledged." No human call. No specific update. No reason for the original cashless rejection provided.
Social media team called — no claim knowledge
A call was received from the company. The caller identified herself as being from the social media team and stated she had no knowledge of the technical claim details or the reason for cashless rejection. She could only repeat the template response: wait 15 working days. A social media team member with no claim knowledge is not a meaningful response to a disputed maternity reimbursement claim.
Day 25 — No reason for rejection provided. No reimbursement processed.
As of today, 25 days since admission, the family has received zero reimbursement. The only communications received have been automated SMS acknowledgements and a template callback from a social media team member with no claim knowledge. The one question that remains unanswered: on what specific medical or documentary ground was the cashless claim rejected, when every submitted document contradicts the stated reason?
What went wrong — documented concerns
Query based on a year that does not exist
The insurer demanded records for a 2022 miscarriage. No such event occurred. The year 2022 appears to be an error in the insurer internal records that formed the basis of the original delay.
Precautionary medicine treated as pre-existing disease
TSH of 3.469 uIU/ml is within the normal adult range of 0.55 to 4.78. Treating doctor certified in writing that the medicine was purely precautionary for conception support. TPO Antibodies were Negative.
Zero human response in 19 days
12 calls. Multiple emails. Hospital follow ups. IRDAI complaint. Every response was automated. No named person called back or provided a specific written answer at any point.
Denial of service on Sunday during hospitalization
An executive stated that senior staff are unavailable on Sundays. A maternity patient at 36+ weeks of pregnancy was told the insurance company does not work on weekends.
NICU newborn bill denied as a cascade
The newborn admitted to NICU from day zero was covered under the policy. Because the primary cashless was denied, the Rs. 95,407 newborn bill was also paid entirely in cash.
Complaint officer never contacted claimant
Mr. Swaroop Paul was assigned on 10 May 2026 with a written two-week commitment. As of 26 May 2026, no contact was made. Nodal Officer Mr. Vikash Agrawal also did not respond to direct written escalation.
We paid our premiums in full. We disclosed everything honestly. We submitted every document that was asked of us. We still paid Rs. 2,38,569 in cash during the birth of our first child. That experience deserves to be documented clearly and shared publicly.
What this page says
- A documented personal experience with a health insurer during maternity hospitalization
- Verified bill amounts, call logs, complaint reference numbers, and a treating doctor certificate
- Published so other consumers can ask better questions before buying insurance
- Open to correction of any factual error through documentary proof
What this page does not say
- This page is not a court judgment or regulatory finding of any kind
- This page does not make criminal allegations against any person or company
- This page does not ask readers to harass any individual or organization
- This page does not replace professional legal or medical advice
What every policyholder in India can do
Escalation channels available to you
- IRDAI Bima Bharosa Portal — bimabharosa.irdai.gov.in
- Insurance Ombudsman — 2/2 A Universal Insurance Building, Asaf Ali Road, New Delhi 110002
- Ombudsman Email — oio.delhi@cioins.co.in
- District Consumer Disputes Redressal Commission — Consumer Protection Act 2019, Section 35
- National Consumer Helpline — 1800-11-4000 (free of charge)
Key regulations that protect you
- IRDAI Protection of Policyholders Interests Regulations 2017 — Regulation 9 prohibits piecemeal document requests
- IRDAI Health Insurance Regulations 2016 — cashless must be decided in a time-bound manner
- Consumer Protection Act 2019 — deficiency in service and unfair trade practice are actionable
- Insurance Act 1938, Section 45 — repudiation requires proof of fraudulent misstatement, not just suspicion
Questions to ask before buying health insurance
These are questions this family wishes they had asked in writing before choosing an insurer.
| Question to ask your insurer | Why it matters |
|---|---|
| What TSH level will you treat as a pre-existing thyroid condition | Get it in writing. A borderline normal reading can be used to dispute a maternity claim. |
| How quickly do you process cashless for maternity hospitalizations | Delays during discharge force full cash payment at higher market rates, not package rates. |
| Is a newborn covered from day zero and under what exact conditions | If primary cashless fails, the newborn coverage can collapse as a cascade consequence. |
| Who is the named escalation contact available during hospitalization | A ticket number is not the same as a human being you can reach during discharge pressure. |
| What is the exact reimbursement timeline after document submission | Get this commitment in writing before you ever need to use it. |
| Does your grievance team operate seven days a week including Sundays | Maternity admissions and emergencies do not follow a Monday to Friday schedule. |
Your claim was rejected or ignored — here is exactly what to do
This section is written as a practical, step-by-step guide for any Indian policyholder whose insurance claim has been wrongfully rejected, delayed, or ignored. Every step cited here is backed by actual Indian law or IRDAI regulation.
Preserve every single piece of evidence immediately
Before doing anything else, secure your paper trail. Screenshot every WhatsApp message, email, SMS, and call log. Keep originals of every hospital bill, discharge summary, lab report, doctor's letter, and insurance correspondence. Save everything in two separate locations — a cloud backup and a physical folder. Under the Consumer Protection Act 2019, the burden of proof rests on you as the complainant. Evidence is your only weapon.
- Take timestamped screenshots of all insurer replies — including social media replies
- Keep original bills, not photocopies, wherever possible
- Save all SMS acknowledgements with claim reference numbers
- Note every call date, time, duration, and what was said
- If you submitted documents physically, keep the acknowledgement receipt
Write a formal written complaint to the insurer's Grievance Cell
Every insurer in India is required by IRDAI to have a Grievance Redressal Officer (GRO). Under IRDAI Protection of Policyholders Interests Regulations 2017, Regulation 14, the insurer must acknowledge your grievance within 3 working days and resolve it within 15 working days. Write a clear, factual complaint — no emotional language, only documented facts. Send via email with read receipt AND registered post with acknowledgement.
- Address it to the Grievance Redressal Officer by name if known
- State: policy number, claim reference, date of rejection, exact reason given by insurer
- Attach all supporting documents that disprove the rejection reason
- Clearly ask for a written, specific response addressing each document submitted
- Give them a 15-day deadline for resolution before you escalate further
File a complaint on IRDAI Bima Bharosa portal
IRDAI — the Insurance Regulatory and Development Authority of India — operates the Bima Bharosa consumer grievance platform. If the insurer has not resolved your complaint within 15 days or has given an unsatisfactory response, you can escalate directly to the regulator. This creates an official regulatory record which the insurer cannot ignore.
- Portal: bimabharosa.irdai.gov.in
- Helpline: 155255 or 1800 4254 732 (toll free)
- You can also email: complaints@irdai.gov.in
- Attach all correspondence including the insurer's inadequate response
- You will receive a complaint registration number — preserve it
Approach the Insurance Ombudsman — free, fast, and binding
The Insurance Ombudsman is an independent authority established under the Insurance Ombudsman Rules 2017. It is completely free for policyholders. Decisions are binding on insurers for claims up to Rs. 50 lakhs. You must approach the Ombudsman only after exhausting the insurer's internal grievance mechanism (Step 2 above). The Ombudsman must resolve the complaint within 30 days.
- Delhi Ombudsman Office: 2/2A Universal Insurance Building, Asaf Ali Road, New Delhi 110002
- Email: oio.delhi@cioins.co.in
- No lawyer required. No court fee. No filing charge.
- You can represent yourself with your documented evidence
- Covers: rejection of claim, partial payment, delay in settlement, deficiency in service
- Your complaint must be filed within 1 year of the insurer's final reply
File a complaint at the District Consumer Disputes Redressal Commission
Under the Consumer Protection Act 2019, insurance is a "service" and policyholders are "consumers." Any deficiency in service — which includes wrongful rejection of a claim, delay, or misleading communication — is actionable. You can file at the District Commission for claims up to Rs. 50 lakhs. The filing fee is minimal (Rs. 200 to Rs. 2000 depending on claim value). You can represent yourself without a lawyer.
- File at the District Commission in your district of residence or where the cause of action arose
- Grounds: deficiency in service under Section 2(11), unfair trade practice under Section 2(47)
- You can claim the full amount rejected plus compensation for mental agony and harassment
- Interest on delayed payment is also claimable
- National Consumer Helpline: 1800-11-4000 (free)
Civil suit for recovery and damages
If neither the Ombudsman nor the Consumer Forum resolves the matter satisfactorily, you can file a civil suit for recovery of the claim amount, interest, and consequential damages. Under the Insurance Act 1938, Section 45, an insurer can only repudiate a claim on grounds of fraudulent misstatement — not merely on suspicion or technical interpretation. If the insurer cannot prove you made a fraudulent misstatement, their repudiation is legally vulnerable.
- Section 45, Insurance Act 1938 — no repudiation after 3 years unless fraud is proved
- You can also file a police complaint for cheating under IPC Section 420 if there is evidence of deliberate misrepresentation at the point of sale
- Always consult a qualified advocate before taking the civil or criminal litigation route
Specifically: what to do when the rejection reason is factually wrong
Get the rejection reason in writing first
Under IRDAI regulations, every rejection must be communicated with a specific, written reason. If you have only received verbal or template rejections, write formally asking for the precise medical finding, document reference, and policy clause they are relying on. They are obligated to provide this. No written specific reason = no valid repudiation.
Get a counter-certificate from your treating doctor
If the insurer is citing a medical condition you do not have, your treating doctor can issue a certificate specifically addressing the insurer's stated reason. This certificate should be on hospital letterhead, stamped, and should directly contradict the insurer's medical ground with reference to your test values and clinical findings.
Request an independent medical examination
You can request that the Ombudsman or Consumer Forum direct an independent medical examination to assess the clinical validity of the insurer's rejection reason. If your TSH is within the normal range and your treating doctor says you do not have a disease, an independent medical examiner's confirmation is powerful supporting evidence.
Cite IRDAI Regulation 9 — no piecemeal document requests
IRDAI Protection of Policyholders Interests Regulations 2017, Regulation 9 specifically prohibits insurers from raising document requirements in a piecemeal manner. If you were asked for documents multiple times across multiple rounds, cite this regulation specifically in your Ombudsman complaint and Consumer Forum filing.
Which authority handles what — at a glance
| Authority | When to approach | Cost | Time limit | Contact |
|---|---|---|---|---|
| Insurer Grievance Cell | First step — always | Free | 15 working days for resolution | Your insurer's grievance email |
| IRDAI Bima Bharosa | After 15 days with no resolution | Free | File within 1 year | bimabharosa.irdai.gov.in |
| Insurance Ombudsman | After insurer grievance fails | Free | Within 1 year of insurer's final reply | oio.delhi@cioins.co.in |
| Consumer Forum (District) | Any time after purchase | Rs. 200–2000 | Within 2 years of cause of action | 1800-11-4000 |
| Civil Court | Last resort with legal counsel | Court fees apply | Within 3 years | Consult a lawyer |
Frequently asked questions about this page
Have you faced a similar experience
If you have gone through a similar documented claim journey and want it added to a public consumer case list, reach out with your timeline, documents, and summary.