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Senior Denied Health Claim: Forum Orders Rs 5 Lakh Payout
5 Apr
Summary
- Consumer forum ordered insurer to pay Rs 5 lakh with interest and compensation.
- Policyholder's cancer claim was initially denied due to alleged non-disclosure.
- Forum ruled prior cardiac condition was unrelated to cancer treatment.
A 70-year-old Bengaluru resident, Manjula Chandranth Sumathi, has won a significant victory against Star Health and Allied Insurance Company Ltd. After her health insurance claim for breast cancer treatment was repudiated, the II additional Bengaluru Urban district consumer disputes redressal commission has ordered the insurer to pay Rs 4.5 lakh plus 9% interest, along with Rs 20,000 for mental agony and Rs 10,000 for litigation costs. The total payout ordered amounts to nearly Rs 5 lakh.
Manjula had purchased a health policy in April 2023, disclosing diabetes and hypertension. She developed breast cancer in May 2024 and incurred nearly Rs 5 lakh in hospital and pharmacy bills. Her claim was denied by the insurer, who alleged she had concealed a pre-existing cardiac condition, citing records of a past heart ailment and angioplasty. However, the consumer forum observed that the prior cardiac condition had no connection to her breast cancer treatment.
The commission also noted that the insurance company had not conducted any pre-policy medical examinations, despite Manjula being a senior citizen. This lack of due diligence, coupled with the unrelatedness of the previous condition, led the forum to conclude that the claim repudiation constituted a deficiency in service. The policy was ordered to be restored.
