Home / Health / Insurance Rejects Claim Over Chart Error; Consumer Wins
Insurance Rejects Claim Over Chart Error; Consumer Wins
15 Nov
Summary
- Consumer awarded Rs 3.87 lakh after insurer denied claim due to chart error.
- Consumer commission found the insurance company guilty of deficiency in service.
- Insurer continued seeking documentation despite error correction and clarification.
A Delhi consumer commission ruled in favor of a 76-year-old woman who was denied a Rs 3.87 lakh health insurance claim. The woman held policies totaling Rs 35 lakh but faced claim rejection due to an initial, incorrect recording of chronic kidney disease (CKD) in her hospital charts.
Although the hospital corrected the erroneous entry before discharge and provided medical clarification, the insurer repeatedly requested further documents, including an affidavit. The commission found this demand unreasonable, especially as the correction was made during the same admission.
The insurance company cited non-submission of mandatory documents when rejecting the reimbursement claim in April 2024. The consumer commission, however, determined that the insurer failed to process the claim fairly and diligently.
Consequently, the commission directed the insurer to pay the Rs 3,87,391 reimbursement, 6% annual interest from April 25, 2024, Rs 50,000 for mental agony, and Rs 35,000 in litigation costs.
