Consumer forum tells insurance company to pay compensation, reimburse woman's treatment charges with interest

The woman had undergone treatment for umbilical hernia with divarication of recti in August 2023 at a cost of Rs 1.77 lakh.
Aditya Birla Group logo
Aditya Birla Group logo (Photo | Twitter/ AdityaBirlaGrp)
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MADURAI: The Madurai District Consumer Disputes Redressal Commission recently orderedAditya Birla Health Insurance Company Limited to pay a woman Rs 1.77 lakh medical reimbursement with interest, along with Rs 20,000 as compensation and litigation expense, for unfairly rejecting her claim application a year ago.

The woman had undergone treatment for umbilical hernia with divarication of recti in August 2023 at a cost of Rs 1.77 lakh. Since she had taken a group active health insurance policy from the above company for an assured sum of Rs 5 lakh for the period between February 2023 and February 2024, she applied for a medical reimbursement in September 2023.

However, her claim was rejected by the company on the ground that her illness was a result of her previous pregnancy and hence would not be coverable as per their policy conditions. Though the woman produced a certificate from her doctor clarifying that the illness was not a result of her previous pregnancy or C-section, the company failed to consider the same, following which the woman moved the commission seeking compensation.

The president of the commission M Piravi Perumal and member IP Shanmugapriya noted that the company had not chosen to contest the case despite receiving the notice sent by it. Referring to an order passed by the national commission, the president and member said the company's lack of response amounts to admission of the charges levelled against it in the complaint. They held the company guilty of gross negligence in service and unfair trade practice and directed it to reimburse the treatment expenses along with 9% interest and pay a further sum of Rs 20,000 towards compensation and litigation cost within 45 days.  

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