Health Insurance Claim Rejected? Consumer Forum Asks Insurer To Pay Rs 17 Lakh

In a telling example of how insurers sometimes go too far in denying claims, a Coimbatore man had to knock on the doors of the consumer forum after his health insurance claim worth Rs 17.02 lakh was rejected by Tata AIG General Insurance, according to a recent media report. The reason? The insurer claimed he had not disclosed an old knee joint problem — one that had nothing to do with his actual treatment, which was for a severe lung infection. The man had taken the policy in 2020 and was hospitalised for over a month in 2021. Despite submitting all medical records and bills, his reimbursement request was turned down, leaving him shocked and financially drained.

Consumer Forum Finds Rejection Unfair And Orders Full Reimbursement
When the matter was taken up by the Coimbatore District Consumer Disputes Redressal Commission, the forum examined the case closely. It found no link between the previous knee issue and the current illness for which treatment was sought. The forum also noted that the insurance company failed to prove that the man had deliberately hidden medical information.

Calling the insurer’s approach unreasonable, the commission ordered the company to repay the entire hospitalisation cost of Rs 17.02 lakh. Tata AIG was also told to pay Rs 50,000 because of the mental distress they caused, plus another Rs 10,000 to cover legal fees.

A Reminder That Policyholders Have Rights

This whole situation should remind us that as policyholders, we have rights. Insurance isn't just about handing over premiums; it's about putting your foot down when they unfairly reject a claim that's genuinely yours. The forum’s ruling strongly conveys to insurers that policyholders cannot be penalised for minor or unrelated medical history. While full disclosure at the time of buying health insurance is important, insurers, too, must show good faith while processing claims. Rejections based on technicalities or vague reasons only erode trust.

What To Do If a Health Insurance Claim Is Denied

If your health insurance claim is rejected, don’t lose hope. Understand the reason, gather documents, and approach a consumer forum if needed. As this case shows, justice may take time, but it does come.