Ahmedabad Consumer Commission Orders Star Health To Pay ₹2.64 Lakh Mediclaim Deductions With 8% Interest
Summarized by AI; it may make mistakes. Check important info
Summarized by AI; it may make mistakes. Check important info
The Ahmedabad District Consumer Disputes Redressal Commission has directed Star Health and Allied Insurance Company to pay ₹2,64,922 deducted from a woman’s medical insurance claim, along with 8% annual interest, after finding that the insurer had no explicit policy provision to justify the deduction.
The commission also ordered the insurer to pay ₹10,000 in compensation for the mental agony caused to the consumer and ₹5,000 towards the cost of filing the complaint. The outstanding amount must be paid within one month, failing which an additional 2% annual interest will apply, according to the order.
Insurer Paid Only ₹1.78 Lakh Against ₹4.44 Lakh Hospital Bill
Nayanaben Atulkumar Shah and Atulkumar Shah filed the complaint through advocate Mukesh Parikh, president of the Grahak Suraksha ane Pagal Samiti (Consumer Protection and Grievance Committee).
According to the complaint, Nayanaben was admitted to a hospital in January 2024 for a cardiac examination and angioplasty. The total treatment expenses amounted to ₹4,44,722.
However, Star Health paid only ₹1.78 lakh against the claim, deducting ₹2,65,822 from the hospital bill. The insurer reportedly defended the deduction by stating that it was made in accordance with an agreement with the hospital.
Commission Rejects Deduction Based On Hospital Agreement
The commission observed that the insurance policy did not contain an explicit provision allowing the insurer to make the deductions in question.
It held that the amount payable to a policyholder could not be arbitrarily reduced on the basis of an agreement between the hospital and the insurance company.
The commission, however, considered the deduction of ₹900 towards registration fees justified. After accounting for this amount, it directed the insurer to pay the remaining ₹2,64,922.
Insurer Ordered To Pay Interest And Compensation
The commission directed Star Health to pay 8% annual interest on ₹2,64,922, calculated from March 4, 2024, until the amount is fully paid.
In addition to the outstanding claim amount and interest, the insurer must pay ₹10,000 for the mental agony suffered by the complainant and ₹5,000 towards litigation expenses.
The company has been given one month to comply with the order. If it fails to pay within the stipulated period, an additional 2% annual interest will apply, as directed by the commission.
The order underscores that deductions from a medical insurance claim must be supported by the terms of the policy and cannot be imposed arbitrarily on the policyholder.
