A Hyderabad consumer commission has mandated Aditya Birla Health Insurance to reimburse a senior citizen’s hospital expenses, restore his policy, and pay compensation after ruling that the insurer failed to substantiate its claim denial over allegedly non-disclosed hypertension.
A Hyderabad consumer commission has ordered Aditya Birla Health Insurance officials to pay a senior citizen’s hospital expenses, restore his policy and compensate him after finding fault with the rejection of his claim over alleged non-disclosure of hypertension.
The commission said the insurer had failed to produce convincing evidence to support its decision, even though the policy had been in force for years and premiums were paid regularly. It held that the rejection and cancellation amounted to deficiency in service and unfair practice.
According to the complaint, the 67-year-old bought a family health cover in September 2018 for himself and his wife and continued paying premiums until 2024. He was admitted to hospital on December 13, 2023, after suffering chest pain and breathlessness, and spent Rs 93,000 on treatment over a three-day stay.
He argued that his medical details had been shared during the pre-policy check-up and that hypertension had been noted as a possible condition. He also said he had disclosed taking Stamlo 5 mg for a temporary blood pressure issue. The commission recorded that the insurer did not file any supporting documents to justify its stand and found its claim that he had been suffering from the condition since 2017 was not backed by evidence.
The order directed the insurer to reimburse Rs 93,000, pay Rs 10,000 for mental agony and Rs 5,000 towards costs, and reinstate the policy without treating it as cancelled. The commission also said no further action should be taken to cancel the cover on the basis of hypertension or any other reason once the cooling-off period had passed. The insurer’s representatives had argued that the complaint was false and that the matter was governed by the contract terms, but the commission rejected that defence.
The ruling underscores a wider point in consumer insurance disputes: an insurer cannot simply allege non-disclosure and walk away from a claim without proving its case, particularly when the policy has been active for several years and no default in premiums is in dispute.
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