Getting 18 Lakh Health Claim Approved After 365-Day Delay
A small business owner's 18.5 lakh health claim for his father's cardiac surgery was stuck in document verification for 365 days. Max Bupa requested the same documents 4 times. We filed an IRDAI IGMS complaint, escalated to the Ombudsman, and got the full amount plus 8 percent interest within 14 days.
The Situation
Business owner from Rajajinagar submitted a health claim after his father's bypass surgery. Max Bupa kept asking for additional documents — same ones already submitted. No status updates for 365 days.
The Challenge
Break the documentation loop and force a resolution through regulatory channels.
How We Solved It
- Mapped every document submitted over 365 days
- Filed IRDAI IGMS complaint with evidence of the documentation loop
- Notified Max Bupa GRO that the case was on IGMS
- Within 48 hours of IGMS filing, Max Bupa's claims head called to settle
- Negotiated for interest at 8 percent per annum
The Result
Settlement of 18,50,000 plus 1,48,000 interest within 14 days of filing the IGMS complaint.
Key Lessons
- 60+ days of delay is a valid IGMS complaint
- Document everything with dates and reference numbers
- IRDAI IGMS works — insurers respond within 48 hours
- Interest is recoverable on delayed claims
Client Testimonial
"I was sending the same medical reports month after month for a year. When I complained to IRDAI, Max Bupa called me within 2 days. They paid the claim and interest within 2 weeks."