A Delhi consumer commission has directed a private health insurer to pay Rs 1.98 lakh to a Delhi man who had to pay for surgery in April 2024 after his claim was allegedly rejected over a 48-month waiting period for pre-existing diseases. The commission found that the insurer had failed to produce medical evidence establishing that his obstructive sleep apnoea existed before he bought the policy in 2021.

The District Consumer Disputes Redressal Commission, South II, New Delhi president Monika Aggarwal Srivastava and members Dr Rajender Dhar and Ritu Garodia were hearing a complaint by a man, the complainant, who alleged wrongful rejection of his surgery claim seeking Rs 1.73 lakh in medical expenses, Rs 20,603 towards pre- and post-hospitalisation costs, 18 per cent annual interest, Rs 5 lakh compensation and litigation costs.

“While settling the claims, the insurance company should not be too technical… Hence, we find the opposite party (the insurer) guilty of deficiency in service and unfair trade…