Mumbai, July 1: The Thane District Consumer Disputes Redressal Commission has directed Star Health and Allied Insurance Co. Ltd. to reimburse Rs 3,74,874 to a senior citizen after holding the insurer guilty of deficiency in service and unfair trade practice for wrongfully rejecting his mediclaim.
The Commission also awarded 9% annual interest from February 27, 2018, along with Rs 10,000 as compensation for mental agony and Rs 5,000 towards litigation costs.
Mediclaim Dispute
According to the complaint filed by Jayant Madhukar Chavan and Madhukar Ramchandra Chavan, the Thane resident had been continuously covered under Star Health's Senior Citizens Red Carpet Health Insurance Policy since 2015 after porting his policy from another insurer without any break.
In January 2018, Madhukar was admitted to a hospital in Mulund with pneumonia, acute coronary syndrome, diabetes, hypertension and obstructive airway disease.
Following treatment, Jayant submitted a mediclaim for Rs 3,74,874, which the insurer repudiated, alleging suppression of a pre-existing cardiac condition.
The complainants argued that Madhukar had disclosed his diabetes and hypertension when purchasing the policy and had never concealed any history of heart disease. Star Health, however, maintained that he had failed to disclose a previous cardiac arrest.
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Commission Finds Deficiency In Service
Rejecting the insurer's stand, the Commission found no documentary evidence proving that the complainant had suffered a cardiac arrest in 2009 or had suppressed any material facts.
It observed that the insurer had renewed the policy for several years and was aware of his medical condition. The Commission held that the repudiation was arbitrary and unsupported by evidence, making the insurer liable to honour the claim.
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