A consumer complaint was filed by Sandeep Pai, a resident of Bengaluru, against IFFCO-Tokio General Insurance and Paramount Health Services after they denied his 15-year-old son Mukund’s corrective foot surgery claim. The insurers claimed that the problem was a congenital defect present from birth, which was not covered under the policy. However, Pai argued that the surgery was to correct a recently developed deformity, not a congenital defect. The insurers rejected both the cashless treatment and reimbursement claims, leading Pai to file a consumer complaint.<\/p>\n
The complaint was heard by the first additional district consumer disputes redressal commission, which ruled that the denial of the claim amounted to a deficiency in service. The commission observed that the burden of proof lay with the insurers to show that the child’s condition was congenital, but they failed to examine any medical expert to prove their contention. The commission relied on a letter from Rangadore hospital, which clarified that Mukund’s foot deformity was developmental, not congenital, and appeared when he was about seven years old.<\/p>\n
The commission also considered photographs produced by Pai, which showed his son was healthy during childhood, further supporting his case. The insurers had argued that the complaint was not maintainable either in law or on facts, but the commission rejected their arguments. The commission ordered IFFCO-Tokio and Paramount Health Services to jointly and severally pay Rs 2.8 lakh towards medical expenses with 7.5% annual interest from the date of repudiation until realization, aside from Rs 3,000 towards legal costs.<\/p>\n
The case highlights the importance of insurers carefully examining claims and not relying solely on technical grounds to reject them. The commission’s ruling emphasizes that the burden of proof lies with the insurer to show that a condition is congenital, and that they must provide sufficient evidence to support their claims. The case also highlights the importance of consumers being aware of their rights and seeking legal recourse when they feel that their claims have been unfairly rejected. The ruling is a significant victory for Pai and his family, who can now receive the compensation they are entitled to for Mukund’s medical expenses.<\/p>\n","protected":false},"excerpt":{"rendered":"
A consumer complaint was filed by Sandeep Pai, a resident of Bengaluru, against IFFCO-Tokio General Insurance and Paramount Health Services after they denied his 15-year-old son Mukund’s corrective foot surgery claim. The insurers claimed that the problem was a congenital defect present from birth, which was not covered under the policy. However, Pai argued that […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"fifu_image_url":"","fifu_image_alt":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[20,22],"tags":[],"class_list":["post-222442","post","type-post","status-publish","format-standard","hentry","category-iffco-tokio","category-insurance"],"jetpack_featured_media_url":"","jetpack_shortlink":"https:\/\/wp.me\/p9ibIB-VRM","jetpack_sharing_enabled":true,"jetpack-related-posts":[{"id":222678,"url":"https:\/\/smallnews.in\/insurance\/2026\/01\/15\/iffco-tokio-insurance-claim-decision-explained-hyderabad-mail\/","url_meta":{"origin":222442,"position":0},"title":"IFFCO Tokio Insurance Claim Decision Explained – Hyderabad Mail","author":"Team Small News","date":"January 15, 2026","format":false,"excerpt":"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. 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