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Insurer denied cancer claims; Commission orders payout
15 Feb
Summary
- Health insurer ordered to pay Rs 27.99 lakh to cancer patient.
- Insurer denied reimbursement claims citing non-disclosure.
- Commission found insurer's evidence of pre-existing disease lacked credibility.
The District Consumer Disputes Redressal Commission in Chandigarh mandated Niva Bupa Health Insurance Company Limited to pay Rs 27.99 lakh plus interest to a cancer patient whose claims were denied. The commission, passing its order on February 9, 2026, criticized insurers for inventing excuses to deny claims after selling policies. Vidya Bhushan Sharma, the complainant, had his health insurance claims rejected by the company, which alleged he concealed a pre-existing disease.
The insurance company argued that Sharma had been suffering from lung cancer for two years before policy inception. However, the commission found significant gaps in the insurer's evidence, noting that investigation documents were unsigned and unsupported by affidavits. The insurer also failed to produce credible medical records proving the disease predated the policy, as required.
The commission emphasized that the burden of proof for pre-existing illness lies with the insurer. It concluded that the rejection of Sharma's claims was arbitrary, constituting a deficiency in service and unfair trade practice. Consequently, the insurer was directed to pay Rs 27,99,215 with 9% annual interest from March 18, 2023, along with Rs 20,000 for compensation and litigation costs.
