A Delhi consumer commission has held Manipal Cigna Health Insurance liable for wrongly denying a woman’s claim for brain tumour surgery, citing flawed reasoning and procedural lapses, in a case highlighting insurer accountability.
A Delhi consumer commission has held Manipal Cigna Health Insurance liable for wrongly rejecting a woman’s claim for brain tumour surgery, saying the insurer relied on unproven allegations that she had hidden a pre-existing condition. The commission directed the company to pay the outstanding claim amount of Rs 1.58 lakh, along with Rs 50,000 as compensation and Rs 25,000 towards litigation costs.
The case centred on a ProHealth Protect policy that the complainant had been renewing for his wife since 2015. In August 2021, she underwent surgery that left the family with hospital bills of Rs 4.58 lakh. After another insurer covered part of the bill, he asked Manipal Cigna to reimburse the remaining amount. The insurer refused, saying the policyholder had not disclosed a history of diabetes and mesenteric vein thrombosis dating back to 2014.
The complainant countered that the medical record was wrong and that the thrombosis had in fact been present only since 2016. A treating doctor backed that explanation, saying the 2014 reference was an inadvertent error. Even after the Insurance Ombudsman asked the insurer to reconsider the matter, the company rejected the claim again, this time on the ground that documents had supposedly not been submitted, although the complainant said everything asked for had already been provided.
In its order dated July 30, the bench of president Divya Jyoti Jaipuriar and member Rashmi Bansal said the repeated rejections, despite the doctor’s clarification and the Ombudsman’s intervention, amounted to a deficiency in service under the Consumer Protection Act, 2019. The commission also noted that Manipal Cigna filed its written reply after the statutory deadline, so it was taken off the record and the complainant’s evidence went unrebutted.
The ruling adds to a series of consumer cases in which Delhi forums have scrutinised how insurers handle health claims, particularly where they allege non-disclosure or suspicion without clear proof. For policyholders, the practical point is straightforward: if a claim is denied, the insurer still has to show its work. Unproved assumptions, shifting reasons and missing paperwork trails can all become expensive mistakes for the company, especially when the treatment has already happened and the family is waiting on reimbursement.
Disclaimer: This article is intended to inform and educate, not to recommend or endorse any financial product, investment or strategy. Please consider your own financial circumstances and seek professional advice where appropriate before making financial decisions.
