Wrong rejection of medical claim costs company ₹2.35L

Chennai: Wrong rejection of a medical claim has cost Star Health Insurance ₹2.35 lakh after the North District Consumer Commission directed the company to pay the sum to a policyholder.

Though the patient underwent treatment for a serious illness, his claim was rejected by treating a hospital admission as merely diagnostic.The District Consumer Disputes Redressal Commission (North), Chennai, held that the insurer’s repudiation of the claim amounted to a deficiency in service and ordered it to pay ₹2,35,897.92 towards medical expenses, along with 9 per cent annual interest from May 7, 2025, the date on which the reimbursement claim was rejected.The case was filed by T Poongavanam, an employee covered under a group health insurance policy purchased by her employer, Micro Macro Quality Engineering Services.

Her husband, N Tamilarasan, was admitted to Gleneagles Global Health City, Perumbakkam, in June 2023 after suffering from persistent chest pain, breathing difficulties, fever and pleural effusion.

He underwent treatment and several procedures, including pigtail insertion and biopsy, during a four-day hospital stay.According to the complainants, the insurer denied cashless treatment and rejected the reimbursement claim, citing a policy exclusion that bars claims for admissions made primarily for investigation and evaluation purposes.

The family said they spent nearly ₹2.36 lakh on hospitalisation and follow-up treatment and repeatedly sought reimbursement.The commission noted that the complainants had earlier approached the consumer forum, following which the insurer had agreed to reconsider the claim upon submission of fresh documents.

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