Insurance Company Ordered to Pay Compensation to Customer for Rejecting his Claim

A district consumer disputes redressal commission in Kerala has directed a private insurance company to pay Rs 3,67,849 to a customer after it denied his insurance claim, alleging that he had concealed a pre-existing health condition, commission authorities said.

In its recent order, the Ernakulam District Consumer Disputes Redressal Commission directed Star Health and Allied Insurance Company to pay Rs 3,67,849 to the customer, said commission authorities.

The ruling by the Commission comes in response to a complaint filed by K P Rendeep, a resident of Aluva in Ernakulam district, who underwent aortic valve replacement surgery at a private hospital.

Rendeep joined Star Health's Health Optima insurance plan in 2018 and incurred surgery expenses totalling Rs 3,07,849.

Star Health Insurance argued that the complainant's condition existed prior to purchasing the policy and that he had concealed this information. The insurer also contended that the policy did not cover expenses related to pre-existing illnesses during the first two years.

However, the commission, led by Bench Chairman D B Binu, along with members V Ramachandran and T N Sreevidhia, ruled that the rejection of the claim without clear evidence or proper communication violated the trust between the insurer and the customer. The commission stated that such actions could not be allowed to stand.

In addition to the treatment costs, the commission ordered the insurance company to pay Rs 50,000 as compensation and Rs 10,000 for legal costs within 30 days.