A few days back, I came across a shocking instance of wrongful termination of health cover by a leading private insurance company.
I consider this wrongful termination of the coverage based on the events that have unfolded before me. In light of greater information, I may change my opinion. However, at the moment, I do believe the insurance company is at fault in this case.
Here is the timeline of events:
- On May 1, 2017, my client (let’s call him Amit) called up Apollo Munich customer care to purchase a popular health insurance plan. The annual premium was ~Rs 23,000.
- He had a pre-existing condition which he disclosed to the customer care executive (let’s call him Darshi)
- Darshi checked with his supervisor (let’s call him Javi) and replied that such condition was not an issue and that the policy could be issued. Everything was on “recorded line”.
- Payment was made and the policy issued.
- Fortunately (or unfortunately), Amit called me on May 1 and told that he had purchased the plan and disclosed the pre-existing condition over phone.
- I asked him to drop an e-mail about his pre-existing condition and take acknowledgement from the company to avoid any issues later.
- On May 2, Amit dropped an e-mail to Apollo Munich customer care with details about his pre-existing condition and sought acknowledgement.
- On May 8, Apollo Munich dropped a bomb (in an e-mail) on Amit mentioning that his policy was terminated due to suppression of facts at the time of purchase of policy.
- Moreover, the company declined to refund the premium. Rs 23,000 is not a small amount for a middle class family.
I copy an excerpt from Apollo Munich letter
In view of the above suppression of material facts, we hereby serve you this notice of 30 days for termination of your Policy (ab initio/last renewal date). Please note you are not entitled for any benefit under the Policy and the premium paid by you stands forfeited.
What I did?
When Amit informed me about the issue, I shot off an e-mail to grievance cell, customer care and Mr. Antony Jacob, CEO, Apollo Munich. I hope I had the CEO’s correct e-mail id.
I requested the following:
- Either the cover should continue or the entire premium should be refunded.
- A stern action against erring officials.
I got an e-mail from Apollo Munich that they will respond only to Amit as he is the customer. Fair enough. However, they have not provided any meaningful response to Amit either and only sought more time.
Don’t know if this is a trick.
In case the concerned officials did not convey proper information to the underwriting team, perhaps they can re-evaluate the decision by seeking more information about Amit’s medical condition.
If Amit wanted to hide his condition, why will he drop an e-mail the very next day? He merely wanted things on record. If he had issues with the purchase decision, he could have returned the policy in the free-look period.
Final word is yet to be written in this case. I will update the post based on Apollo Munich’s response. I hope sense prevails.
Update (May 13, 2017): Apollo Munich has acknowledged its error and decided to refund the entire premium. The policy stands terminated. In their e-mail, the insurance company didn’t specify why they decided the refund the premium. They have also promised to take action against the erring officials. Persistence has paid off.
What is the bigger issue?
In this case, Amit chose to disclose the illness over e-mail the next day. Swift action got him the refund of premium.
In my opinion, Apollo Munich took a very smooth face-saving action. Their position was untenable. Premium taken and refunded. Case closed.
What if Amit had chosen not to drop an e-mail about the condition?
After all, he disclosed everything on phone, didn’t he?
In such a case, when he would have gone to make a claim in the future and such an illness would have come to light, his claim would have been rejected (in all likelihood).
This could have happened after 5-10 years. Premium for all these years would have gone down the drain.
Not just that, Amit would have been left down by the insurance company at the worst possible time.
Amit’s word against Apollo Munich executives’?
I was not part of the discussion between Amit, Darshi and Javi on May 1, 2017. Therefore, I cannot be sure if Amit was clear in his communication with the customer care executives. Therefore, the insurance company still has some benefit of doubt.
It does not matter if Amit seeks investment advice from me or if I trust him. If Amit didn’t disclose proper information at the time of purchase, the insurance company is well within rights to terminate the plan.
There is only one way of verifying this exchange of information, call records on May 1. Did Apollo Munich go through call records on May 1 before sending policy termination letter? Only Apollo Munich can answer.
Till now, Apollo Munich has shown no interest in sharing such call details. Another problem is what actually got recorded. Perhaps, nothing was recorded. It is quite possible that sales people say such things just to give you confidence.
Apollo Munich, has in its response dated May 12, 2017, mentioned that it may consider sharing such voice logs with Amit. Personally, I feel the insurance company will not share the records.
My Learning from this Experience
To one of my other clients, an executive from a different insurance company advised not to disclose a particular health condition because that will result in denial of cover.
Given my inherent distrust towards insurance companies, I believe such instances are not isolated.
What I do not know if it is a case of a few rotten apples or does this have something to do with organization culture? It is possible that such aggressive sales at any cost approach is rewarded by the insurance companies.
Please understand such executives have sales targets and will do anything to make a sale. Of course, not everyone is bad.
What should you do?
I also acknowledge that many of us may not be comfortable entering details on the website at the time of purchase. You would rather give your health details over phone. However, you need to make sure that the details are correctly captured.
Here is what you can do:
- Do NOT trust customer care executive in sales teams. Keep the conflict of interest in mind.
- Do NOT let the sales executive decide what is material or not. If they had their way, even cancer will be immaterial. They have the incentive to make a sale.
- Get everything on record. Let the underwriting team (and not the sales executive) decide if the illness/ailment is material or not.
- Ask the executive to send you a copy of the proposal form over e-mail (before you make the payment). Verify the details before making the payment.
- Before making the payment, send an e-mail to customer care detailing your condition. Mention names of the executives you are talking to. Seek acknowledgement before you make the payment.
I have read about instances where crooked insurance agents removed sheets about health disclosures before forwarding the proposal forms to the insurance company. This increased the chances of getting the policy issued. Clearly, the policyholder would have faced issues later.
Now you know that mis-selling can happen even if you purchase insurance online (or directly from the insurance company).
Caveat emptor.
Do note this is not a commentary on Apollo Munich or whether you should purchase insurance from the company. Such cases can happen with any insurance company.
You do not control what insurance companies will do. You can only control what you can do.
Make sure that you disclose complete medical information at the time of purchase of policy and ensure that such information is recorded.
Will be great if you could tell me
- What else can be done in this case to get a fair resolution? Yes, Amit can write to IRDA or raise complaint on Integrated Grievance Management System (IGMS). That is an option once Apollo Munich responds negatively.
- If you have been through such a case and how you responded? Others will learn from you experience.
- Can First Information Report (FIR) be filed against the erring officials?
Book Suggestion: The Behavior Gap: Simple Ways to Stop doing Dumb Things with Money (Carl Richards)
24 thoughts on “How Apollo Munich Health Insurance tricked my client?”
I also own a Apollo health policy for past 7 years and this post really worries me. Till now I have not claimed anything, so, don’t know how will they treat me at that time. But you post really shows how money hungry and unprofessional they are. I would request you not to leave them and file a consumer complaint with insurance regulator and also consumer court.
Thanks for showing concern, Ritesh.
The risk that the insurance company may not honour a claim despite payment of premium for many years is always there.
Since the alignment of interest is completely reverse, you can always expect insurance try to figure out a way to reject a claim.
In case of health insurance, you are atleast around to fight it out and counter claims of insurance companies.
In case of life insurance, you can’t even do that. Family will be left to fight the hawks.
That’s the way it is.
Recent update: By the way, in this case, Apollo Munich has acknowledged its error and decided the refund the entire premium.The company has written that they will take action against the erring officials. Therefore, persistence has paid off in this case. I will update the post accordingly.
However, I still don’t know what would have happened if the issue was highlighted only at the time of claim.
Hi Deepesh,
I have taken Apollo Munich insurance for my mother in May 2016 and it was a telephonic call with their customer care that started the process. They sent an agent home to get the application filled up and signed with all the details including pre-existing illness, etc. Also the premium was decided based on the illness, if any. It took a couple of weeks for the entire process to complete which included medical test, cheque encashment and policy underwriting. The policy document they mailed me had an e-copy of the application which I filled up.
So it puzzles me when you say there was a telephonic conversation and the policy was issued on the same day particularly after an illness was disclosed.
Have they started issuing policies without filling forms, medical tests,etc?
Hi Pradeep,
Let me explain with the help of an example.
If the executive asks you about treatment during the last two years, you mention stomach problems. He says “not important” and does not include in the proposal form. You don’t mind either.
Similarly, for any other illness, if he mentions not important, nothing goes in the application form. Again, you are ok (you shouldn’t be though).
Medical tests are not conducted for everyone. Only above the age of 45, do they get serious about medical tests. Before that, everything is on self-declaration basis. If they find something worth investigating,they might ask you to go for a medical test.
From what I have been, if there is something worth investigating, insurers reject the application for their cheaper variants.
E-issuances are quite quick.
Such copies are sent (and if sent) only after issuance of policies. Damage is already done by the time.
Hi Deepesh, Could you suggest me the visitor’s Medical policy taken for specific time period, say 140 days to US and which one is better Public sector companies like United India Insurance or ICICI Lambert. Secondly the premium is quite high–Maor Bala
Hi Major Bala,
Travel insurance should do. You looking for something else?
Simply Brilliant Article by Mr. Deep. Outstanding way of resolving an issue. You are certainly helping all the netizen Indians who are visiting your forum by posting excellent reviews on every article with deep insights and complete in-dept subject-matter expertise. Hope I got to utilize your Paid service in near future as I feel guilty in utilizing all the FREE materials you have posted in your website. Congratulations Sir!! Keep it up!!
You are welcome, Bavan. Keep coming back to the website.
Invite you to join the Facebook page too for regular updates.
Please share the post with you friends.
The quality of all health policies would not be known until they are put to test with a claim, You will get a million excuses from the insurers to disallow or reduce your claim amount to suit them.With the marketing of policies being so serious, nothing else comes to the mind of the sales executives,except the target, leave alone the welfare of the client>
Completely agree. As they say, you can’t tell how good your life cover is, only your nominee can.
In insurance, interests of the policyholder and insurer are not exactly aligned.
More so in case of term and health insurance. Insurance company is happy with you only so long as you do not make a claim and keep paying premium.
Can anybody throw light on life insurance cases, as to in what situation the insurance company will not pay?
For my life insurance, medical test was done by insurance company only, so I hope all risk is theirs for any kind of death case, which they have to pay.
Tapan,
Insurance companies rely on what you disclose. Even medical tests are based on your disclosures.
They don’t ask you to go for complete medical checkups.
Hi,
Last year, I applied for a health insurance from Apollo Munich, I had stated my existing illness which is Thyroid and Cholesterol. A week later my application was rejected because they were not willing to accept me because of my declared pre-existing illness. They refunded my premium in a weeks time, In my case they were transparent but I was expecting that I would be asked to pay a higher premium for my existing illness, never thought that they would reject my application outright.
Do we have any insurance company which offers health cover for customer’s with pre-existing Thyroid and Cholesterol? I am 39 year old strict non-smoker.
Hi Kiran,
You will have to check with different insurers. Thyroid shouldn’t be as big a problem. Cholesterol is.
The sad reality is every health insurance company wants only healthy people in their fold.
Try public insurers.
Hi Deepesh,
I found this article one of the good one available for those who are looking to buy online health insurance.
And I want to know that what are the information comes under existing illness. If the person hd the treatment previously and it is perfectly cured, those kind of information also we have disclose?
And Thanks for the information.
Hi Mohan,
Thanks. Please share with your friends too so that they can also benefit.
It is your responsibility to disclose everything to the insurance company.
Let the insurance company decide the information about cured illness is material or not.
In my opinion, every illness (cured or not cured) is critical for underwriting.
Therefore, please disclose.
Hi every one beware of APOLLO MONICA HEALTH INSURANCE.
Recently I brought Apollo Munich health insurance. After 40 days they were said your baby not eligible for police. I was shocked. I asked to customer care why did you accept my policy. I had paid 20000/-.
How did you verify after joined. If any thing wrong don’t accept my money. You have used 20000/-of money nearly 40 days.
Thanks TVR for your inputs!!!
Can you please elaborate on the issue?
After harassed by Apollo Munich claim team I wrote to Apollos Ceo.
they are not paying my simple fever bills then how should we trust them for other treatment charges which
they assure us to pay. be careful Freinds.
Hi, Apollo Munich Ceo Mr. Anotny.
Your company is harassing me by not paying my claim. My Policy No is XXXXXX.I don’t know what happens to you people because after sending you so many requests for reimbursement of my claim you people keep rejecting the claim with baseless issues. I sent you the letter of Doctor in which he mentioned very clearly that fever goes down as he gave me antibiotics against typhoid during my stay they did a lot of tests and found nose polyps which are in my body. But Doctor mentioned clearly that he has not treated me against polyploids.
But your company keep telling me that nose polyploids come under your 2 years policy that is why your company can,t pay my claim of 44,000 Rs. Your company is making people believe/trust that after getting insured by you people you will pay their hospital bills of 5, 10 or 20 lakhs but in my case, you are not paying 44,000 Rs only. I am going to launch a complaint in the police for harassing me and against fraud then also go to consumer court.
Dear Hemant,
I can understand your frustration and anger.
Please understand this blog is not tracked by Apollo Munich.
I have removed policy details from your comment to avoid misuse.
Please write an e-mail to grievance cell of the insurance company. In case that does not work, you can raise compliant on IGMS portal.
You can also approach consumer court.
Hi sir,
I had applied for Optima Restore health insurance for myself and my mother in HDFC ERGO Health Insurance Ltd through agent. It is Multi individual policy with 10 Lakhs sum insured each. But it is rejected after payment. I have got full refund.
I am physically disabled person since my birth. I had given all documents to the agent. He filled the online form and uploaded documents and I got a call from a doctor of HDFC ERGO.
I told them the medical admission history of my mother and about my disability. Then they have told it is fine and sent me a proposal form and payment link.
After payment was done, I found that there was some mistakes in dates in medical history in proposal form. So I sent mail to customer care of HDFC ERGO regarding this and also explained the medical history in detail in mail for their official record purpose and attached the scanned medical reports. After 2-3 days, I got a SMS saying that my application has been rejected.
They knew that I’m a disabled person and my mother had medical history. Even after that also they had accepted and made me to do Payment. I don’t know why they rejected after payment.
They provided the following reasons for rejection:
For Myself: On account of Achondroplasia with Dwarfism.
For my mother: On account of abnormal MRI findings, Iron deficiency anemia and acute sinusitis.
I want your help. Is there anyway to apply again a fresh application. I am badly looking to buy health insurance from HDFC ERGO.
Awaiting got your reply. Thank you.
Hi Ravi,
I understand insurance application rejection can be frustrating. This happens all the time.
Applications are rejected for the most flimsy of reasons. Has happened with many of my clients too. So, just move on.
The way it works: First, you make the premium payment. Then, they will process the application. Subsequently, if they don’t want to cover you, they will reject the application and refund the premium.
Don’t waste your time with HDFC Ergo. They won’t cover you now. Try with a different insurer.
Since you have a slightly complicated medical history, you may need external help in figuring out the right plan for you. This way, the hit and trial effort will reduce.
If you want, I can connect you with Securenow, an insurance broker. Or you can connect with them on your own.
Hope this helps.
Thank you for providing such valuable information on your blog.
I am planning to purchase a health insurance policy for my wife and myself. But i am really not clear as to what all should be mentioned as pre-existing conditions.
1. My wife who is 24 years old, recently had a miscarriage, it is at the time of early pregnancy (June 2020) when we detected she had Hypothyroidism and she has been taking medication since then. Her thyroid levels are normal now. Should we mention the miscarriage besides Hypothyroidism to the Insurance company?
2. I am aged 30 and do not have any condition or disease for which i am currently taking medication. However 4 years back (late 2016) i had a cyst growth(Pilonidal cyst) for which i had to undergo an incision. No medication was prescribed and the incision procedure was hardly 10 minutes. I never had this thereafter as well. Now should i be mentioning this condition?
Similarly i have alopecia and have taken PRP therapy to reduce hair loss and promote hair growth. This was in 2018 and thereafter i have taken some medication on recommendation of the Dermatologist to reduce hair loss. I believe this is a cosmetic treatment. Should this be mentioned as Pre-existing condition?
3.When i checked with ICICI lombard regarding my wife’s condition over call they said i would not have to pay additional premium. And they said that i have to mention only diseases/conditions for which i had taken medication or treatment? But do you suggest i get a written confirmation on these above conditions and the premium based on this from the insurance company and take a decision based on their proposal?
4. Since i and my wife are young the insurance companies do not undertake pre-policy check-ups, but do you suggest i do a complete medical check-up at my own expense before buying a policy to ensure i do not face any claim rejection on a later date?
5. Another one of my big confusions is whether to take an individual or family-floater policy. When doing the math i feel the individual policy is more logical since the difference in premium is very little compared to the benefits such as individual no-claim bonus besides a possible policy cancellation for all members for family floater based on some missed information. However since we are a young couple and expecting kids, family floater looks like a better choice since the kids can be included for an overall lower premium. What would you suggest?
Sorry this is a long query, but i have been spending many weeks now trying to understand policies to take a decision. I do not want to delay buying a policy but i lack confidence after reading such rejection stories from other insured people. Thank you in advance for taking your time and answering my queries.
Hi Nitish,
Thanks!!!
1. Hypothyroidism is quite common. You disclose the levels and the medication. Disclose about the miscarriage too. That’s not really pre-existing illness.
2. Disclose about the procedure. Don’t think alopecia is a problem. They won’t cover treatment for Alopecia anyways. So, disclose and don’t worry about that.
3. Over and above the online/offline proposal form, do send them an e-mail about your other treatment/procedures that you have gone through. Remember the people who you talk to before/during purchases are salespeople. They have to meet targets. They want you to buy. They don’t care whether the claims will be rejected. Don’t rely on their verbal confirmation. Counts for little later.
4. They usually don’t have such provisions. However, you can always send them your latest medical checkup reports over e-mail and ask them to consider these.
5. For young families such as yours, go with a family floater.
You can never be 100% sure about insurance purchases. Do due diligence ofcourse. Take a leap of faith and hope that the insurance company won’t fail you later.