Hyderabad: The Telangana Consumer Disputes Redressal Commission has ruled that if an insurance policy is issued to a senior citizen without conducting medical tests, the insurer must bear the associated risk and cannot later reject claims on that basis.
The Commission clarified that allegations of pre-existing diseases cannot be made without proof, and the burden of establishing such claims lies with the insurance company.
Case details
According to the case details, G Manmohan had purchased a health insurance policy from Star Health Insurance in 2019 and had been paying an annual premium of Rs 26,550.
Three years later, he was hospitalised due to a urinary tract infection, incurring medical expenses amounting to Rs 2.26 lakh. However, the insurance company rejected his claim, alleging that he had pre-existing medical conditions prior to obtaining the policy and had failed to disclose them.
Following the rejection, Manmohan and his legal heirs approached the District Consumer Commission, which ruled in their favour and directed the insurer to reimburse the medical expenses.
Star Health files appeal
Challenging this order, Star Health Insurance filed an appeal before the State Consumer Commission.
A bench comprising Commission President Justice G Radharani and Member RS Rajeshwari heard the matter and upheld the earlier order. The Commission directed Star Health Insurance to pay Rs 2,26,329 towards medical expenses along with 9 percent annual interest.
Additionally, the insurer was ordered to pay Rs 10,000 as compensation and Rs 5,000 towards litigation costs.
The Commission emphasised that insurers cannot issue policies without conducting medical examinations and later deny claims by alleging pre-existing conditions without substantiating evidence.
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