The record
Written from the 1 report below. Nothing here is unsourced.
- A Punjab district consumer commission has ordered Star Health and Allied Insurance to pay a woman Rs 26,882 after the company rejected her claim for her son's dengue treatment.
- The insurer had cited discrepancies in hospital records, but the commission found these were in documents prepared by the hospital, beyond the policyholder's control, and were not even mentioned in the rejection letter.
- It also noted the insurer never verified the records with the hospital before rejecting the claim.
- The company must pay Rs 21,882 for medical expenses plus Rs 5,000 as compensation and litigation costs within 30 days, or an additional Rs 3,000.
What to watch next
- Whether Star Health complies with the order within 30 days or faces the additional Rs 3,000 penalty
- Whether the insurer appeals the commission's decision to a higher forum
Who said what2
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District Consumer Disputes Redressal Commission
2 quotes · 1 outlet
“We are of the considered view that all the discrepancies as mentioned above seems highly absurd and are beyond the control of the complainant... Further, the said discrepancies are not mentioned in the repudiation letter dated 29.11.2025 issued by Opposite Parties, so the same are not maintainable”
In the article
…related to hospital records, which were prepared by the hospital and were beyond the complainant's control. It also noted that these grounds were not even mentioned in the repudiation letter issued to the complainant. " We are of the considered view that all the discrepancies as mentioned above seems highly absurd and are beyond the control of the complainant... Further, the said discrepancies are not mentioned in the repudiation letter dated 29.11.2025 issued by Opposite Parties, so the same are not maintainable ," the commission held. The commission also observed that if the insurer genuinely doubted the hospital records, it should have verified the documents with the hospital before rejecting the claim. However, it found no…
“Had the Opposite Parties get verified from the hospital concerned about the discrepancies... then they would have been justified in repudiating the claim... However, there is no document showing that it ever get verified from the hospital concerned”
In the article
…that if the insurer genuinely doubted the hospital records, it should have verified the documents with the hospital before rejecting the claim. However, it found no evidence that the company had made any such effort. " Had the Opposite Parties get verified from the hospital concerned about the discrepancies... then they would have been justified in repudiating the claim... However, there is no document showing that it ever get verified from the hospital concerned ," the bench noted. The commission further held that the insurer had failed to prove any wrongdoing by the complainant and that the medical treatment was genuine. It noted that the company itself had assessed the…
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Coverage1
All filed from India
Named India · Star Health and Allied Insurance · Aparana Kundi · Dhaliwal Child Care Centre · District Consumer Disputes Redressal Commission · Mohinder Singh Brar · Priti Malhotra
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