A Himachal Pradesh consumer court has ordered an insurer to pay over Rs 2 lakh after ruling that claims denied on alleged undisclosed hypertension lacked sufficient medical evidence, highlighting growing scrutiny of insurer claim rejection practices in India.
A consumer commission in Himachal Pradesh has upheld an award of more than Rs 2 lakh to a policyholder after rejecting an insurer’s attempt to deny a health claim on the grounds that he had hidden a history of hypertension. The commission said the company had not produced medical records proving that the condition existed before the policy began, and that a bare assertion in the repudiation letter was not enough to defeat the claim.
The dispute arose after the man bought a health policy with a sum insured of Rs 5 lakh, valid from May 11, 2023, to May 11, 2024. In February 2024, while the policy was active, he was admitted to hospital with chest pain and diagnosed with a heart problem that required urgent treatment. The hospital billed him Rs 1,47,891, which he paid before filing a claim.
The insurer later rejected the claim, saying he had suffered from high blood pressure for four years and had failed to disclose it when taking the policy. But the Himachal Pradesh State Consumer Disputes Redressal Commission said the company had not backed up that allegation with “cogent and convincing medical evidence”. It also noted that the discharge slip did not record any earlier ailment. The bench upheld the district commission’s order for reimbursement of the hospital bill, interest, Rs 50,000 in compensation and Rs 12,000 in litigation costs.
The ruling fits a wider pattern in Indian consumer forums, where insurers have increasingly faced scrutiny for denying claims on the basis of alleged non-disclosure of pre-existing conditions. Industry guides and reporting on claim disputes show that hypertension, diabetes and similar illnesses are among the most common reasons cited for rejection, but consumer commissions have repeatedly said such allegations must be supported by clear medical proof. Recent decisions in other states have also gone against insurers where they could not establish that a condition pre-dated the policy or where the evidence was not strong enough to justify repudiation.
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