The district consumer commission in Noida has directed Star Health Insurance to settle a medical insurance claim of Rs 14,716 for a Dankaur resident, along with interest at 6 percent per annum from the date of complaint filing in April 2023 until the payment is made. The order was issued on May 2 by commission president Anil Kumar Pundir and member Anju Sharma, who also mandated an additional Rs 2,000 for mental agony and litigation costs, to be paid within 30 days of the judgment.
Background of the Case
Bijendra Singh, the complainant, approached the commission after his claim application to the insurance company was ignored. Singh informed the commission that he had purchased a Rs 5 lakh mediclaim policy with a one-year validity on October 23, 2021. In September 2022, he was admitted to Sukhamal Dalchand Numberdar Hospital with a high fever. He stated that he notified the insurance company, which issued a claim number. After a three-day hospital stay, he was discharged after settling the bill, relying on the company's assurance that expenses would be reimbursed upon submission of bills and diagnostic reports.
Allegations of Service Deficiency
Singh alleged that after submitting the required documents, the insurance company stopped responding. Despite repeated follow-ups, the company only sent a message stating that the claim had failed. When Singh sought the reason for rejection, the company did not provide a satisfactory explanation. He argued that this behavior constituted a deficiency in service. The commission sent notices to the insurance company, but no response was received. Consequently, the commission proceeded with the matter on February 27, 2025, in the absence of the insurance company.
Commission's Verdict
The commission observed that the insurance company had committed a service deficiency by rejecting the claim despite Singh having paid the entire premium on time. It concluded that Singh's complaint was admissible and ordered the payment of the claim amount with interest, along with compensation for mental agony and litigation costs.
This case highlights the importance of timely response and fair assessment of claims by insurance providers. Consumers are advised to maintain proper documentation and approach consumer forums if their legitimate claims are denied without valid reasons.
