Mani V

[Mani V @manivelusamy]

@drmdnr Why are you cancelling the whole train, why can't you short terminate the train, if severe congestion New Delhi is your concern? Don't you feel shame for putting your passengers stranded by cancelling the entire train journey?

[Mani V @manivelusamy]

@HDFCERGOGIC Hi Nishant, I did receive a call and mail from ur team finally, after 2 months. Still "no one yet answered" me Y did U reject my claim even though I gave all evidence & how finally accepted my claim. There is no answer. This is what concerning me to trust @HDFCERGOGIC .

[Mani V @manivelusamy]

🧵 Health Insurance Reality Check – My Experience with Claim Rejection & Final Approval

1/ My daughter underwent a medically necessary squint (exotropia) eye surgery.

Claim submitted to @HDFCERGOGIC .

Result? ❌ Rejected.

Reason: “External congenital condition” (excluded).

[Mani V @manivelusamy]

Thanks for finally engaging a human being to support my case.. the case is resolved, and I am refunded for the rotten apple.. thanks to the human being and I hate you AI.

[Mani V @manivelusamy]

@zeptocares I raised a complaint for rotten products received, but I was denied of refund. What this?

My mobile number 9865359475
Order ID: TURRJGGNQ24229
Ticket Code: TKDC1F97C66CA

And I wrote a mail, and your team is claiming seller confirmed they sent quality products. 1/2

[Mani V @manivelusamy]

@zeptocares Thanks for finally engaging a human being to support my case.. the case is resolved, and I am refunded for the rotten apple.. thanks to the human being and I hate you AI.

[Mani V @manivelusamy]

@zeptocares am i cheating you or you are and your seller is cheating me?

[Mani V @manivelusamy]

@HDFCERGOGIC 9865359475
[email protected]

[Mani V @manivelusamy]

@HDFCERGOGIC Hi Nishant, just wanted to tell you, no body contacted me.

[Mani V @manivelusamy]

@HDFCERGOGIC I DMed. Happy to connect with anyone from the team to share how badly you treated your customer during the hard times. No valid reason behind the rejection given, you made me to escalate in multiple channels, thousands of mails, and now approved the claim. How is it happened now?

[Mani V @manivelusamy]

10/ I want to thank my HR Taruna, TPA side support executive Chhaya, ChatGPT, Dr Aloka, Anusha from the clinic for all the support. Thanks.

Writing this here just to let the people know about how bad HDFC ERGO played in this case. @HDFCERGOGIC

[Mani V @manivelusamy]

9/ While I’m relieved, it’s concerning that:

Claim was rejected without clear evidence

Multiple escalations were needed for a fair outcome

Hope @HDFCERGOGIC improves transparency in such decisions.

#HealthInsurance #ClaimRejection #ConsumerRights

[Mani V @manivelusamy]

8/ Key takeaways:

Don’t accept rejection blindly

Ask for evidence-based justification

For group policies → involve HR/TPA

Use escalation channels (Grievance → Ombudsman)

@hdfcergogic

[Mani V @manivelusamy]

7/ Turning point:
👉 Claim reopened 👉 Re-evaluated with full evidence

Final outcome after 45 days of wait:
✅ Claim APPROVED

💰 ₹62,672 credited

✔ No deductions

@hdfcergogic

[Mani V @manivelusamy]

6/ Also used ChatGPT to:

Draft structured emails

Understand policy language

Plan escalation steps

Helped me stay consistent and evidence-focused.

@hdfcergogic

[Mani V @manivelusamy]

5/ I submitted:

✔ Doctor’s certification (NOT congenital)

✔ Childhood photos (no early signs)

✔ Consultation history

All clearly showed it was not present since birth

@hdfcergogic

[Mani V @manivelusamy]

4/ Once HR stepped in:

Case was internally escalated properly

Insurer reopened the claim

Requested supporting documents

@hdfcergogic

[Mani V @manivelusamy]

3/ I continued escalation:

Customer care

Grievance team

Insurance Ombudsman

At this stage, Ombudsman asked whether the case was also routed via HR (since it's a group policy).

@hdfcergogic

[Mani V @manivelusamy]

2/ This was surprising because:

Doctor clearly certified it is NOT congenital

No evidence was provided by insurer

Repeated follow-ups didn’t give a proper justification

@hdfcergogic