The District Consumer Disputes Redressal Commission of Ranga Reddy in Hyderabad has ordered Niva Bupa Health Insurance Company to pay a 72-year-old senior citizen a compensation of Rs 94,584 with an interest rate of 9% for her cataract surgery. The company had rejected the claim citing pre-existing conditions, including high blood pressure, atypical chest pain, and irregular heartbeat due to heart block. However, the commission found the rejection unjustified, stating that the insurer had conducted a medical examination before issuing the policy and couldn’t link the cataract surgery to the pre-existing conditions.
The commission also ruled that the company couldn’t challenge the policy after the three-year post-issuance period, citing relevant sections of the Insurance Act. Additionally, the commission cited a Supreme Court ruling that once a policy is issued after a medical examination, insurers cannot deny claims based on disclosed medical conditions.
The commission awarded the complainant Rs 20,000 as compensation and Rs 10,000 as legal costs. Niva Bupa has been given 45 days to comply with the order, failing which the interest rate will increase to 12% per annum. The ruling is a significant victory for the complainant and sets a precedent for other insurance policyholders. It highlights the importance of transparency and fairness in the insurance industry, ensuring that policyholders are not disadvantaged due to unjustified rejections of claims. The commission’s decision will likely lead to a review of Niva Bupa’s claims process and may encourage other insurance companies to follow similar guidelines to ensure fair treatment of policyholders.