Consumer Commission Orders Compensation for Wrongful Mediclaim Rejection
Insurance company penalised for wrongful rejection of mediclaim
The Times Of IndiaImage: The Times Of India
The North District Consumer Commission in Chennai has ordered Star Health Insurance to pay ₹66,711 (approximately $800 USD) after wrongfully rejecting a mediclaim for a 51-year-old resident. The insurer denied the claim citing pre-existing diabetes, despite the waiting period having lapsed, leading to a compensation order for mental agony and litigation costs.
- 01Star Health Insurance was penalized for wrongful claim rejection.
- 02The commission ordered a total payment of ₹66,711, including interest and compensation.
- 03The claimant had disclosed her diabetes when purchasing the policy.
- 04The insurer's rejection was deemed arbitrary after the waiting period expired.
- 05This case reinforces consumer rights against unfair insurance practices.
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The North District Consumer Commission in Chennai, India, has ruled in favor of a 51-year-old woman whose mediclaim was wrongfully rejected by Star Health Insurance. The insurer denied a claim of ₹36,711 (approximately $440 USD) for hospitalization due to urosepsis and acute pyelonephritis, citing pre-existing diabetes, despite the fact that the waiting period had lapsed. The commission deemed the insurer's actions arbitrary and ordered a total payment of ₹66,711, which includes ₹25,000 for mental agony and ₹5,000 for litigation costs, along with 9% interest on the claim amount. The woman had purchased a comprehensive health insurance policy with a sum insured of ₹5 lakh (approximately $6,000 USD) on March 21, 2022, fully disclosing her diabetes and opting for a buy-back clause that reduced the waiting period for pre-existing conditions to 12 months. This case underscores the importance of consumer rights in ensuring that insurance companies honor valid claims.
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This ruling reinforces the rights of policyholders in Chennai and across India, ensuring that insurance companies cannot unjustly deny claims.
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