Now Reading: Consumer forums rule against Care Health Insurance in two claim cases
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Consumer forums rule against Care Health Insurance in two claim cases
The Story in Brief
Two district consumer commissions have separately ruled against Care Health Insurance, holding its claim rejections amounted to deficiency in service. On 13 October, the Gurgaon forum directed the insurer to reimburse over Rs 19.6 lakh in medical expenses incurred by a woman for her husband’s treatment before his death, plus Rs 2 lakh compensation and Rs 55,000 litigation costs. The forum observed that an insurer must conduct a thorough medical examination before issuing a policy and cannot later deny a claim on grounds of non-disclosure of pre-existing diseases.
On 12 October, the Mohali forum ordered the insurer to reimburse Rs 74,000 in medical and ambulance charges to a Dera Bassi woman, plus Rs 25,000 compensation and litigation costs. The commission noted that the policy exempted spinal conditions arising from accidents from the 24-month waiting-period restriction, and the insurer had initially approved cashless treatment before withdrawing it. Both orders carry interest penalties: 9% annually from December 2023 in the Gurgaon case and 6% annually from October 2022 in the Mohali case. The insurer has 45 days from the order upload date to comply, with higher interest for delay.
Indian Opinion Analysis
The two orders against Care Health Insurance, though factually unrelated, are reported with the same neutral-report stance by both outlets. Times of India leads with the Gurgaon forum’s broader legal principle, that an insurer cannot reject a claim for pre-existing disease without a pre-policy medical test, and foregrounds the Rs 19.6 lakh award. Hindustan Times leads with the Mohali forum’s narrower finding that the policy’s waiting-period clause exempted accident-caused spinal conditions, and foregrounds the Rs 74,000 award. Neither outlet criticises the insurer beyond quoting the forum’s finding of deficiency in service. Both end on the compliance deadline and interest penalty, giving the reader a concrete watch item: the 45-day payment window from the order upload date.
Coverage: 2 sources, 2 neutral
Sources (2): timesofindia.indiatimes.com (neutral report), hindustantimes.com (neutral report)
This brief was synthesised by AI from the 2 sources linked above, so one read covers every framing they carry. Methodology and corrections.
