A Srinagar man has won Rs 1.36 lakh from an insurance company after it refused to reimburse the cost of his wife’s ankle surgery, citing a pre-existing heart condition that it claimed had not been disclosed when the policy was renewed. The consumer commission found that the insurer had failed to provide evidence to support its claim that the heart condition had not been disclosed.

A bench of president Farah Deeba and member Shabnam Munshi was hearing the complaint filed by a man whose wife was also covered under his health insurance policy and underwent surgery after fracturing her right ankle in August 2024.

“The complainant has established his entitlement to reimbursement of the admissible medical expenses proved on record, and that the opposite party (insurance company) has failed to substantiate the ground of non-disclosure relied upon to justify denial of the claim,” the October 22 order read.

Fall, surgery, bills

The man claimed that he secured the health insurance policy effective from May 2024 to…