Misguided into getting ICL eye surgery by insurance agent — now claim is being denied. What are my legal options?

[Irafox58]

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Irafox58
PARTICIPANT
April 7, 2025 at 2:24 pm

Hi all,

I have corporate health insurance from Niva Bupa, with Medi Assist as TPA. A few months ago, an agent from MediBuddy (linked to Medi Assist) convinced me to get ICL eye surgery, repeatedly assuring me it was covered (90% reimbursed, 10% copay). He even booked my surgery, coordinated with the hospital, and guided me throughout.

I trusted his word and got the surgery on March 8, 2025. Now, my claim is being delayed and likely denied, since ICL and toric lenses are excluded under policy terms. I have WhatsApp chats and emails showing the agent clearly told me it was covered.

Do I have any legal recourse for this misrepresentation? Should I go to the IRDAI, consumer court, or escalate internally to IBM HR first?

Any help would be appreciated.

TL;DR: Insurance agent from MediBuddy misled me into getting ICL surgery claiming it was covered. Now the claim is being rejected. I have proof. Need advice on legal steps I can take.

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[Desiknight9081]

D

Desiknight9081
PARTICIPANT
April 7, 2025 at 2:38 pm

First complain to the company’s grievance redressal cell. If they fail to resolve it, then write to IRDAI.

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[Salonipanther485]

S

Salonipanther485
PARTICIPANT
April 7, 2025 at 4:54 pm

Do that, plus go after that agent by filing a criminal complaint.

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[Happydude6149]

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Happydude6149
PARTICIPANT
April 7, 2025 at 5:00 pm

Ombudsman.

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