A Nainital resident, Neelam Mehrotra, has finally received relief from the state consumer commission 13 years after her knee surgery claim was denied by United India Insurance Co Ltd (UIICL). The commission reversed a 2016 district commission order and directed UIICL to pay Mehrotra ₹1.5 lakh for the claim, ₹1 lakh for mental distress, and ₹50,000 in litigation costs.
Mehrotra had undergone knee surgery in July 2012, after informing UIICL in advance, and submitted bills totaling ₹3.5 lakh for reimbursement. However, the insurer denied her claim, citing that she had not completed the mandatory four-year waiting period for pre-existing conditions. The insurer claimed that Mehrotra’s policy was a fresh one, not a ported one, making her ineligible for knee replacement coverage.
However, Mehrotra had previously held a Mediclaim policy with another insurer, New India Assurance Co Ltd, since 2005, and had ported her policy to UIICL under Insurance Regulatory and Development Authority (IRDAI) rules. The state commission found that this earlier coverage had not been properly accounted for, and that IRDAI’s portability provisions had been followed.
The commission examined documents and concluded that the district commission had incorrectly dismissed Mehrotra’s complaint without valid justification. The commission ruled that Mehrotra had fully proved the deficiency on the part of UIICL beyond any reasonable doubt, and allowed her appeal. UIICL has been directed to pay Mehrotra the claimed amount, compensation, and litigation expenses within one month.
The commission’s order is a significant victory for Mehrotra, who had been fighting for her rightful claim for over a decade. The ruling highlights the importance of properly accounting for previous insurance coverage and following IRDAI’s portability provisions. It also serves as a reminder to insurance companies to carefully review and process claims, rather than relying on technicalities to deny them.