Health insurance company directed to reimburse Rs 3.42 lakh to customer
According to official sources, M Baskar Ilango of Kuniyamuthur took a health insurance policy through
HDFC Bank
in Feb 2020. The policy was renewed regularly, and the premium for the period from Feb 29, 2024 to Feb 28, 2025, was duly paid.
Ilango was admitted to a private hospital with acute anterior wall myocardial infarction on Feb 28, 2024. He underwent a coronary angiogram on Feb 29 and off-pump coronary artery bypass grafting on March 4, incurring hospital expenses of Rs 3.42 lakh.
He submitted claim forms to the insurer on the day of admission.
The insurer initially informed him that the claim was being processed but later rejected it, citing that he had been suffering from diabetes mellitus for five years and failed to disclose it.
Ilango filed a petition with the commission, contending that he was diagnosed with diabetes only in Feb 2024 and produced medical records, including reports showing normal sugar levels at the time of policy inception.
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He alleged that the denial amounted to an unfair trade practice.
District consumer disputes redressal commission president R Thangavel and member P Marimuthu observed that the insurer had failed to establish its claim of pre-existing illness, and deficiency of service was evident. They directed the private health insurance company to reimburse Rs 3.42 lakh to Ilango for medical expenses and Rs 10,000 as compensation.
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