Commission rules insurer wrongly rejected claim citing decades-old treatment; orders payout of Rs 3.01 lakh with interest, compensation, and costs to policyholder.

Hyderabad: The Consumer Commission–I has held ManipalCigna health insurance guilty of illegal claim rejection and deficiency in service for denying a medical reimbursement on the grounds of alleged non-disclosure of decades-old treatment.

The Commission directed the insurer to pay Rs 3,01,071 towards treatment expenses, along with 9 per cent interest calculated from the date the claim was rejected.

In addition, the complainant is to be paid Rs 30,000 as compensation and Rs 10,000 towards litigation costs.

The order was passed by Commission–I member V Janardhan Reddy on a complaint filed by M Satyanarayana and his wife B Saraswathi.

As per the case record, Saraswathi was admitted to Siddhartha Hospital on May 25, 2024, after severe leg pain left her unable to walk. The cost of treatment exceeded Rs 3 lakh. She later approached the insurer for reimbursement under her health insurance policy.

ManipalCigna rejects claim

However, ManipalCigna rejected the claim, alleging that Saraswathi had suppressed information regarding medical treatment taken at the age of 18, as well as treatment for a brain haemorrhage six years ago, at the time of obtaining the policy.

Challenging the rejection, the complainants approached the Consumer Disputes Redressal Commission, which ruled that the insurer’s action was unjustified.

The Commission observed that repudiating a claim based on decades-old treatment amounted to unfair practice and constituted a deficiency in service.