Thane Consumer Court Orders Star Health to Pay Rs 3.74 Lakh to Senior Citizen
The Thane District Consumer Disputes Redressal Commission has ordered Star Health and Allied Insurance Co. Ltd. to reimburse Rs 3,74,874 to a Thane resident after ruling that his medical claim was wrongfully rejected. The commission found the insurer guilty of deficiency in service and unfair trade practice against senior citizen Madhukar Ramchandra Chavan.
Madhukar had been continuously covered under Star Health’s Senior Citizens Red Carpet Health Insurance Policy since 2015. He had ported his policy from another insurance provider without any break in coverage.
In January 2018, Madhukar was admitted to a hospital in nearby Mulund to receive treatment for pneumonia, acute coronary syndrome, diabetes, hypertension, and obstructive airway disease.
Following his medical treatment, Jayant Madhukar Chavan submitted a mediclaim for Rs 3,74,874. Star Health repudiated the claim, alleging that the patient had suppressed a pre-existing cardiac condition, specifically a previous cardiac arrest.
The complainants challenged the rejection, arguing that Madhukar had disclosed his diabetes and hypertension when purchasing the policy and had never concealed any history of heart disease.
Upon reviewing the case, the consumer commission rejected the insurer's stand. The commission noted that there was no documentary evidence to prove that Madhukar had suffered a cardiac arrest in 2009 or had suppressed any material facts.
The commission observed that Star Health had renewed the policy for several years and was well aware of his medical condition. It held that the repudiation of the claim was arbitrary and unsupported by evidence, making the insurer liable to honour the policy.
As part of its ruling, the commission directed Star Health to pay the claim amount of Rs 3,74,874 with 9 percent annual interest, calculated from February 27, 2018. Additionally, the insurer was ordered to pay Rs 10,000 as compensation for mental agony and Rs 5,000 towards litigation costs.
