Court orders Star Health to pay Rs 76,000 to consumer over claim rejection

KOCHI: The District Consumer Disputes Redressal Court ordered the Star Health Insurance Company to pay compensation of Rs 76,000, including medical expenses and court costs, to the petitioner for not providing insurance benefits for Covid treatment. The order said that the company' not covering the cost despite the policyholder having right to cashless treatment was a deficiency in their service and an unethical business practice.

The verdict was given by the consumer court, presided by DB Binu and V Ramachandran and TN Sreevidya as members, on a complaint filed by Puthankurish native Reji John.

In January 2021, the complainant was treated for dengue and Covid. The court rejected the company's contention that he had not produced all the necessary documents to allow the claim. It cannot be assumed that the average person will fully understand each and every provision of the policy before signing it. The consumer court also pointed out the position of the Supreme Court that in situations where the policy clause is ambiguous and two interpretations are possible, it is preferable to take a position in favour of the consumer.