SBI General ordered to pay Rs 1.88 lakh after rejecting Karnal woman’s health insurance claim

The District Consumer Disputes Redressal Commission, Karnal, has directed the SBI General Insurance Company Ltd. to settle the health insurance claim to complainant with interest for the treatment of her son. The Commission termed the rejection of the claim as ‘unfair practice’.

The Commission directed the insurance company to pay Rs 1,88,241 to the complainant with interest of 9 percent annum from the date of repudiation of the claim (January 1, 2025) till its realisation.

Besides, the Commission bench comprising President Jaswant Singh, and members Neeru Agarwal and Saravjeet Kaur also directed the company to pay Rs 25,000 to the complainant for mental pain, agony and harassment and Rs 11,000 as litigation expenses.

As per the order, Vijay Rani, a resident of Sadar Bazar in the city, approached the Commission, alleging that she had purchased a health insurance policy from the company which was valid from January 1, 2024 to January 10, 2025.

Her son was admitted at Alchemist Hospital, Panchkula, in December 2024 after being diagnosed with right-sided pleural effusion and lower respiratory tract infection.

The family incurred medical expenses of over Rs 2.18 lakh after the company allegedly denied cashless treatment and later rejected the reimbursement claim.

The insurance company defended its decision, saying that the child had a history of congenital heart disease, for which surgery had been performed earlier, and alleged that the ailment had not been disclosed at the time of obtaining the policy. It maintained that the claim was liable to be rejected on the ground of non-disclosure of a material fact.

The complainant argued that the congenital heart condition had been disclosed to the insurance agent while purchasing the policy. The treating doctors at Alchemist Hospital also clarified that the previous heart disease had been successfully treated years earlier and this past medical history was unrelated to the current health issues. The complainant alleged that the company’s refusal was an unfair trade practice.

The Consumer Commission, headed by President Jaswant Singh directed the insurance company to settle the claim to provide relief to the complainant.