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Insurance Rejects Claim, Commission Orders Payout
21 Sep
Summary
- Insurance company ordered to reimburse ₹50,700 plus interest.
- Claim rejection cited prior eye condition; commission found no link.
- Policyholder awarded ₹15,000 for mental agony and litigation costs.
A District Consumer Disputes Redressal Commission has mandated ManipalCigna Health Insurance to reimburse ₹50,700 to a policyholder, overturning a claim rejection. The commission ruled that the insurer could not establish a connection between a prior eye condition and the cataract for which the claim was made.
ManipalCigna had rejected the claim on January 31, 2026, citing the policyholder's medical history dating back to May 16, 2013, and alleging non-disclosure. However, the commission noted that the previous treatment concerned the right eye, while the recent surgery was for a cataract in the left eye.
Consequently, the commission ordered the insurer to pay 9% annual interest on the ₹50,700 from January 31, 2026, until the payment is settled. Additionally, ₹15,000 was awarded to the complainants for mental agony, harassment, and litigation expenses, underscoring a successful consumer protection case.
