Health insurance company told to pay Rs 6.25 lakh to Ludhiana resident

The Punjab Consumer Disputes Redressal Commission has directed Star Health and Allied Insurance Company Limited, Chennai, to compensate Kulwinder Singh, a Ludhiana resident, with Rs 6.25 lakh, along with 7 per cent interest from the date his claim was denied. The commission also ordered an additional Rs 40,000 as compensation and Rs 11,000 in litigation expenses.

The order came after Singh’s insurance claim was rejected by the company on the grounds that he had not disclosed his pre-existing joint pain condition, for which he received treatment in Gurugram in 2017. The company argued that Singh had concealed his medical history when purchasing the policy in 2015.

The commission, led by President Justice Daya Chaudhary and members Simarjot Kaur and Vishav Kant Garg, upheld the decision of the Ludhiana Consumer Commission. The order criticised the insurance company’s claim denial, stating that the company was free to conduct medical examinations of prospective buyers and should not have relied solely on the buyer’s disclosure.

Additionally, the commission suggested that an advisory be issued to the Insurance Regulatory and Development Authority of India (IRDAI) to mandate medical examinations for all policy buyers before issuing health policies. Currently, only those above 50 years are subject to mandatory medical checks.