Archive · 25 Jul 2025
Consumer Court Sides with Man Denied Insurance Claim in Indore
A man named Suresh Kumar Jain had a health insurance claim rejected by his insurance company.
He had a heart problem and needed a stent.
The insurance company said his problem was pre-existing.
However, a consumer protection group called the Grahak Panchayat helped him fight the decision.
They argued that his health problem was common.
The Consumer Commission agreed and ordered the insurance company to pay his claim, plus extra money for his trouble.
Suresh Kumar Jain's health insurance claim was initially rejected by Oriental Insurance Company.
Jain had a stent implanted in his heart in 2017 after experiencing chest pain.
The insurance company cited a policy clause restricting coverage for pre-existing conditions.
The Akhil Bharatiya Grahak Panchayat (ABGP) filed a case on Jain's behalf.
The Indore District Consumer Commission ruled in favor of Jain, ordering payment.
- Who
- Suresh Kumar Jain, Oriental Insurance Company, Akhil Bharatiya Grahak Panchayat (ABGP), Indore District Consumer Commission.
- What
- The Indore District Consumer Commission ruled in favor of Suresh Kumar Jain, who had his health insurance claim denied.
- When
- The incident occurred in 2017 and the case was decided recently.
- Where
- Indore, India
- Why
- Jain's health insurance claim was denied based on a policy clause, and the consumer commission ruled in his favor because of the circumstances and the advocacy of the ABGP.
Oriental Insurance Company
Akhil Bharatiya Grahak Panchayat (ABGP)
Coverage of Pre-existing Conditions
Oriental Insurance Company
Denied the claim based on a clause about pre-existing conditions.
Akhil Bharatiya Grahak Panchayat (ABGP)
Claim should be paid because the pre-existing conditions are now a common part of everyday life and denying the claim is a deficiency in service.
- Policyholder
- Suresh Kumar Jain
- Insurance Company
- Oriental Insurance Company
- Policy Type
- Happy Family Floater Medical
- Date of Policy Purchase
- August 14, 2013
- Medical Procedure
- Stent Implantation
- Hospital
- Vishesh Hospital, Indore
- Claim Amount
- ₹2,49,581
- Interest
- 6%