Madurai: The Madurai District Consumer Disputes Redressal Commission has ordered Aditya Birla Health Insurance Company Limited to reimburse a woman Rs 1.77 lakh, with 9% interest, for her medical expenses and to pay an additional Rs 20,000 for compensation and litigation costs. The woman had undergone treatment for an umbilical hernia with divarication of recti in August 2023 and filed for reimbursement under her group health insurance policy, which was active from February 2023 to February 2024 with a coverage of Rs 5 lakh.
Her claim was initially rejected by the insurance company, which argued that her condition was due to a previous pregnancy and therefore not covered. Despite providing a doctor’s certificate confirming the condition was unrelated to her pregnancy, the company refused her claim. Consequently, she approached the consumer commission.
The commission, led by President M Piravi Perumal and member IP Shanmugapriya, noted that the insurance company did not contest the case, effectively admitting to the charges. The commission ruled the company’s actions as gross negligence and an unfair trade practice, ordering it to settle the reimbursement and compensation within 45 days.
