CLAIM REPUDIATION LETTER WITHOUT PREJUDICE

Date : 23-Sep-2024 Claim Number : RR-HS24-14341338

Subject : Denial of Claim No.: RR-HS24-14341338

Dear VISHAL YADAV ,

We refer the captioned claim intimated on 17/07/2024 and have carefully reviewed the documents with utmost sensitivity on the basis of the documents
submitted, to validate the eligibility of the claim basis policy terms and conditions.

Hereby, we sincerely regret to inform you that the claim for Optima Secure - Family fails to meet the eligibility as per the Policy terms and conditions.
Since the claim is not admissible, we are constrained to deny the claim. The reason for denial of the claim is being mentioned below for your ready
reference:

1.As per the submitted claim documents, the claimant was hospitalized on 07/06/2023 with the diagnosis of synovitis knee. After srutiny of the documents,
it was also found that the duration of hospitalization of the claimant was prolonged in a health condition where his treatment could have been managed on
OPD (Out Patient Department) basis and hence the treatment given was not medically necessary during the course of admission. As per Definition 33 of
policy terms and conditions, medically necessary means any treatment, test, medication, or stay in hospital or part of stay in hospital which (i) is required
for medical management of the illness or injury suffered by the insured person, (ii) must not exceed the level of care necessary to provide safe, adequate
and appropriate medical care in scope, duration or intensity. Hence in the purview of Definition 33 of the policy, this claim is being repudiated.

We sincerely express our inability to serve you, given the circumstances. However, we look forward to service your requirements in future.

Authorized Signatory

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 Customer Service Address: D 301, 3rd Floor,
CIN: U66030MH2007PLC177117, Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234 / +91-120 6234 6234 | www.hdfcergo.com
 Grievance Redressal Procedure

In case you are not satisfied with our response or want to lodge a complaint, you may:
ƕ Call our 24*7 customer care number 022 6234 6234 / 0120 6234 6234 or write to us at care@hdfcergo.com from your registered
contact details.
ƕ Senior citizen customers can call us at 022- 6242-6226 or write to us at seniorcitizen@hdfcergo.com from their registered contact
details.

Escalation level 1: For lack of a response or if the response provided does not meet your expectation, you can write to:

The Complaints & Grievance Cell

HDFC ERGO General Insurance Company Limited
D-301, 3rd Floor, Eastern Business District (Magnet Mall),LBS Marg,
Bhandup (West), Mumbai- 400078e-mail: grievance@hdfcergo.com

After examining the matter, final response would be conveyed within a period of 15 days from the date of receipt of your complaint on this e-mail id.

Escalation level 2: In case, you are not satisfied with the decision/resolution of the above office, or have not received any response within 15 days, you
may write to

The Chief Grievance Officer

HDFC ERGO General Insurance Company Limited
D-301, 3rd Floor, Eastern Business District (Magnet Mall),LBS Marg,
Bhandup (West), Mumbai- 400078e-mail: e-mail: cgo@hdfcergo.com

Escalation level 3: If after following Escalation Level 1 and 2 as stated above your issue remains unresolved, you may approach the respective
Insurance Ombudsman situated at your Union Territory, District your for Grievance Redressal.Details of the Ombudsman offices are given below for your
reference.

NAMES OF OMBUDSMAN AND ADDRESSES OF OMBUDSMAN CENTRES

Office Details Jurisdiction of Office (Union Territory, District)

AHMEDABAD Gujarat,
Office of the Insurance Ombudsman, Dadra & Nagar Haveli,
Jeevan Prakash Building, 6th floor, Daman and Diu.
Tilak Marg, Relief Road,
Ahmedabad ±380 001.
Tel.: 079 - 25501201/02/05/06
Email: bimalokpal.ahmedabad@cioins.co.in
BENGALURU Karnataka.
Office of the Insurance Ombudsman,
Jeevan Soudha Building,PID No. 57-27-N-19
Ground Floor, 19/19, 24th Main Road,
JP Nagar, Ist Phase,
Bengaluru ±560 078.
Tel.: 080 - 26652048 / 26652049
Email: bimalokpal.bengaluru@cioins.co.in
BHOPAL Madhya Pradesh
Office of the Insurance Ombudsman, Chattisgarh.
Janak Vihar Complex, 2nd Floor,
6, Malviya Nagar, Opp. Airtel Office,
Near New Market,
Bhopal ±462 003.
Tel.: 0755 - 2769201 / 2769202
Fax: 0755 - 2769203
Email: bimalokpal.bhopal@cioins.co.in
BHUBANESHWAR Orissa.
Office of the Insurance Ombudsman,
62, Forest park,
Bhubneshwar ±751 009.
Tel.: 0674 - 2596461 /2596455
Fax: 0674 - 2596429
Email: bimalokpal.bhubaneswar@cioins.co.in

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 Customer Service Address: D 301, 3rd Floor,
CIN: U66030MH2007PLC177117, Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234 / +91-120 6234 6234 | www.hdfcergo.com
 CHANDIGARH Punjab,
Office of the Insurance Ombudsman, Haryana(excluding Gurugram, Faridabad, Sonepat and Bahadurgarh)
S.C.O. No. 101, 102 & 103, 2nd Floor, Himachal Pradesh, Union Territories of Jammu & Kashmir,
Batra Building, Sector 17±D, Ladakh & Chandigarh.
Chandigarh ±160 017.
Tel.: 0172 - 2706196 / 2706468
Fax: 0172 - 2708274
Email: bimalokpal.chandigarh@cioins.co.in
CHENNAI Tamil Nadu,
Office of the Insurance Ombudsman, PuducherryTown and
Fatima Akhtar Court, 4th Floor, 453, Karaikal (which are part of Puducherry).
Anna Salai, Teynampet,
CHENNAI ±600 018.
Tel.: 044 - 24333668 / 24335284
Fax: 044 - 24333664
Email: bimalokpal.chennai@cioins.co.in
DELHI Delhi &
Office of the Insurance Ombudsman, Following Districts of Haryana - Gurugram, Faridabad, Sonepat & Bahadurgarh.
2/2 A, Universal Insurance Building,
Asaf Ali Road,
New Delhi ±110 002.
Tel.: 011 - 23232481/23213504
Email: bimalokpal.delhi@cioins.co.in
GUWAHATI Assam, Meghalaya,
Office of the Insurance Ombudsman, Manipur, Mizoram,
Jeevan Nivesh, 5th Floor, Arunachal Pradesh,
Nr. Panbazar over bridge, S.S. Road, Nagaland and Tripura.
Guwahati ±781001(ASSAM).
Tel.: 0361 - 2632204 / 2602205
Email: bimalokpal.guwahati@cioins.co.in
HYDERABAD Andhra Pradesh,
Office of the Insurance Ombudsman, Telangana, Yanam and
6-2-46, 1st floor, "Moin Court", part of Union Territory of Puducherry.
Lane Opp. Saleem Function Palace,
A. C. Guards, Lakdi-Ka-Pool,
Hyderabad - 500 004.
Tel.: 040 - 23312122
Fax: 040 - 23376599
Email: bimalokpal.hyderabad@cioins.co.in
JAIPUR Rajasthan.
Office of the Insurance Ombudsman,
Jeevan Nidhi ±II Bldg., Gr. Floor,
Bhawani Singh Marg,
Jaipur - 302 005.
Tel.: 0141 - 2740363
Email: bimalokpal.jaipur@cioins.co.in
ERNAKULAM Kerala,
Office of the Insurance Ombudsman, Lakshadweep,
2nd Floor, Pulinat Bldg., Mahe-a part of Union Territory of Puducherry.
Opp. Cochin Shipyard, M. G. Road,
Ernakulam - 682 015.
Tel.: 0484 - 2358759 / 2359338
Fax: 0484 - 2359336
Email: bimalokpal.ernakulam@cioins.co.in
KOLKATA West Bengal, Sikkim,
Office of the Insurance Ombudsman, Andaman & Nicobar Islands.
Hindustan Bldg. Annexe, 4th Floor,
4, C.R. Avenue,
KOLKATA - 700 072.
Tel.: 033 - 22124339 / 22124340
Fax : 033 - 22124341
Email: bimalokpal.kolkata@cioins.co.in
LUCKNOW Districts of Uttar Pradesh :
Office of the Insurance Ombudsman, Lalitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur,
6th Floor, Jeevan Bhawan, Phase-II, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur,
Nawal Kishore Road, Hazratganj, Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti,
Lucknow - 226 001. Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar,
Tel.: 0522 - 2231330 / 2231331 Sultanpur, Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria,
Fax: 0522 - 2231310 Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar.
Email: bimalokpal.lucknow@cioins.co.in

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 Customer Service Address: D 301, 3rd Floor,
CIN: U66030MH2007PLC177117, Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234 / +91-120 6234 6234 | www.hdfcergo.com
 MUMBAI Goa, Mumbai Metropolitan Region excluding Navi Mumbai & Thane.
Office of the Insurance Ombudsman,
3rd Floor, Jeevan Seva Annexe,
S. V. Road, Santacruz (W),
Mumbai - 400 054.
Tel.: 69038821/23/24/25/26/27/28/28/29/30/31
Fax: 022 - 26106052
Email: bimalokpal.mumbai@cioins.co.in
NOIDA State of Uttaranchal and the following Districts of Uttar Pradesh:
Office of the Insurance Ombudsman, Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kanooj,
Bhagwan Sahai Palace Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah,
4th Floor, Main Road, Farrukhabad, Firozbad, Gautambodhanagar, Ghaziabad, Hardoi, Shahjahanpur,
Naya Bans, Sector 15, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar,
Distt: Gautam Buddh Nagar, Saharanpur.
U.P-201301.
Tel.: 0120-2514252 / 2514253
Email: bimalokpal.noida@cioins.co.in
PATNA Bihar, Jharkhand.
Office of the Insurance Ombudsman,
1st Floor,Kalpana Arcade Building,,
Bazar Samiti Road,
Bahadurpur,
Patna 800 006.
Tel.: 0612-2680952
Email: bimalokpal.patna@cioins.co.in
PUNE Maharashtra,
Office of the Insurance Ombudsman, Area of Navi Mumbai and Thane excluding Mumbai Metropolitan Region.
Jeevan Darshan Bldg., 3rd Floor,
C.T.S. No.s. 195 to 198,
N.C. Kelkar Road, Narayan Peth,
Pune ±411 030.
Tel.: 020-41312555
Email: bimalokpal.pune@cioins.co.in

For any further information please visit www.irdai.gov.in

HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 Customer Service Address: D 301, 3rd Floor,
CIN: U66030MH2007PLC177117, Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234 / +91-120 6234 6234 | www.hdfcergo.com