Archive · 3 Jan 2026
Insurance Company Ordered to Pay for Wrongful Mediclaim Repudiation
A court in Ahmedabad, India, has ordered an insurance company to pay a large sum of money to a customer.
The insurance company had wrongly refused to pay for the customer's medical treatment, saying the customer had a pre-existing condition called hypertension.
The court found that the insurance company did not have enough evidence to prove this.
The court also said that the insurance company must pay interest on the money, as well as compensation for the legal costs.
This decision helps protect customers from unfair practices by insurance companies.
The case was brought by an organization that works to protect consumers' rights.
The District Consumer Disputes Redressal Commission, Ahmedabad, found The Oriental Insurance Company Limited guilty of 'deficiency in service' for wrongfully repudiating a mediclaim.
The Commission directed the insurer to pay Rs 5 lakh (sum insured) with 7% interest, along with compensation and litigation costs.
The case involved the hospitalization of the complainant's husband for palpitation in 2018 and subsequent ailments in 2019.
The insurer failed to prove suppression of material facts regarding hypertension, which was cited as a pre-existing disease to deny the claim.
The Commission rejected the insurer’s objection on limitation, holding that the complaint was within time in view of the Supreme Court’s suo motu orders extending limitation during the Covid-19 period.
- Who
- The District Consumer Disputes Redressal Commission, Ahmedabad (Additional) and The Oriental Insurance Company Limited
- What
- The insurance company was found guilty of 'deficiency in service' for wrongfully repudiating a mediclaim
- When
- The complaint was filed on December 24, 2023
- Where
- Ahmedabad, India
- Why
- The insurer failed to prove suppression of material facts regarding hypertension, which was cited as a pre-existing disease to deny the claim
- Complainant
- Wife of the insured
- Insurance Company
- The Oriental Insurance Company Limited
- Amount to be Paid
- Rs 5 lakh (sum insured) with 7% interest
- Compensation
- Compensation and litigation costs
- Pre-existing Disease Cited
- Hypertension
- Year of Hospitalization
- 2018 and 2019
- Organization Filing Complaint
- Consumer Education and Research Centre (CERC)
- Commission's Decision
- Deficiency in service by the insurance company