Case Details:
We had given a Customer a mediclaim policy of ₹5 lakhs in the month of June 2024, and he had to undergo a Bypass in Dec 2024.
July 25, 2025
Important Background:
We had given a Customer a mediclaim Policy of HDFC ERGO of ₹5 lakhs in the month of June 2024, and he had to undergo a Bypass in December 2024. We had clearly asked the Customer about his Health Conditions, and there were none.
Normally, the mediclaim policy is issued at utmost good faith, i.e., whatever the customer says, the Insurance company believes it and issues the policy.
It was a shock for us also, as the Bypass claim had arisen within 6 Months of policy issuance. The Customer was admitted to Lilavati Hospital in Mumbai, and the Bypass was scheduled on the third day.
Solution:
As an Insurance expert, we were concerned about how to tackle this early claim. We discussed with the customer and asked him if he had hidden any facts from us. When we were convinced, we assured him not to worry.
In an early claim, the Insurance company always initiates an Investigation. It is a lengthier process. The Investigation team will thoroughly investigate and then give its decision to the claims team about approving or not approving the case for cashless.
The challenge with us was that everything had to be done in 2 days, including a visit by the Insurance Company to the Hospital. In a normal Scenario, an investigation takes at least 15 days. We were left with only 2 days to complete everything.
We immediately requested the higher-ups at the HO of HDFCERGO to intervene and help us. HDFC ERGO acted very fast on our request, and the investigation was completed in a day.
The Customer got cashless Approval before his Bypass surgery.
The Estimate for the bypass was ₹6.5 Lakhs, and the policy was for only ₹5 Lakhs.
HDFCERGO settled the claim for 100% as the product we had offered to the customer was HDFC Secure, where the customer gets double the Sum Assured. His policy was for 5 lakhs, and he got 10 10-lakh cover.
Conclusion:
Always take advice from an agent who is in the market for at least 10 Years and choose a wise company like HDFCERGO.