Hyderabad: The Hyderabad District Consumer Commission-II has directed Niva Bupa Health Insurance to pay Rs 20 lakh to a policyholder.
It ruled that a visible disability like polio cannot be treated as a concealed medical condition.
Policyholder’s claim was rejected
The complainant, Soodini Padma Reddy, a resident of Banjara Hills, had been living with polio since he was three years old.
Despite renewing his health insurance policy with Niva Bupa since 2019, he was left with no option but to pay his treatment cost of Rs 23.5 lakh in May 2024 when he underwent heart surgery at a private hospital.
When he sought reimbursement under his health insurance policy, the insurance company rejected the claim, stating that he had not disclosed his childhood polio earlier.
Consumer Commission’s observations
Padma Reddy challenged the decision before the Consumer Commission.
For the past five years, the company’s representatives had been collecting the premiums and were aware of his polio, he argued.
He further said that the company’s empanelled doctors had examined him when the policy was first issued.
The Bench, comprising Commission President Vakkanti Narasimha Rao and Member Parupalli Jawahar Babu, observed that polio does not come under the concealment of a medical condition, as the physical disability is clearly visible.
Commission directs insurance company to pay
Concluding that the rejection of the claim was unjustified, the Commission directed Niva Bupa Health Insurance to pay Rs 20 lakh to the insurer.
The company was also directed to pay Rs 2 lakh to the insurer as compensation for the mental agony.
Moreover, the company was directed to pay Rs 10,000 towards litigation costs and deposit Rs 1 lakh into the Telangana Chief Minister’s Relief Fund.
