The District Consumer Disputes Redressal Commission, Medak, has ruled in favor of a policyholder, Patlolla Madhusudhan Reddy, whose health insurance claim was rejected by IFFCO Tokio General Insurance Company Ltd. Reddy, a 61-year-old businessman, had purchased a family health protector policy for himself and his wife, paying a premium of ₹24,143. When he was hospitalized in March 2024, a representative of the insurer visited the hospital, assured a cashless settlement, and collected documents.
However, the company later repudiated the claim, citing that the hospital was on its excluded list. The commission found that the insurer’s rejection of the claim after giving assurance of settlement amounted to a deficiency in service and unfair trade practice. The policy was valid, and Reddy was entitled to the benefit. The commission held that the insurer’s defense, stating that the claim was non-admissible due to the hospital being on its excluded list, was not valid.
The commission directed IFFCO Tokio to pay ₹1,58,122 with 9% annual interest to Reddy, along with ₹10,000 as compensation for mental agony and ₹5,000 as litigation costs. The insurer was given 40 days to comply with the order. The commission’s decision highlights the importance of insurers adhering to their commitments and providing fair treatment to policyholders. The order also emphasizes that technical grounds cannot be used to reject claims after assurances have been given.
The case serves as a reminder to insurance companies to ensure that their representatives are aware of the policy terms and conditions and do not make false promises to policyholders. It also underscores the need for transparency and fairness in the insurance industry. The commission’s ruling is a victory for Reddy, who had faced significant financial hardship due to the rejection of his claim. The order will likely have implications for the insurance industry, emphasizing the need for companies to prioritize customer satisfaction and adhere to their commitments.