SANGAREDDY: Insurer ordered to pay ₹2.29 lakh for denied cancer treatment claim

Sangareddy: The District Consumer Disputes Redressal Commission, Medak at Sangareddy on September 18, 2025, partly allowed a complaint by retired bank officer Jakkampudi Svskn Prasad and directed Care Health Insurance Ltd (formerly Religare) to reimburse medical expenses of ₹2,29,000 and pay additional sums for mental agony and litigation costs. The commission found deficiency in service and unfair trade practice in the insurer’s handling of the claim.

Insurer had rejected claim citing pre-existing disease

The commission found that the insurer repudiated the claim for treatment of the complainant’s wife — who underwent a mastectomy on July 30, 2020 — on the ground that the breast lump constituted a pre-existing condition within the policy’s waiting-period exclusion. The commission, however, accepted the complainant’s evidence that diagnostic reports confirming malignancy were produced on February 4, 2020, about four months after the group policy began on 24 October 2019, and held the repudiation to be improper.

Order directs payment with interest and small compensation

The commission directed the opposite parties, jointly and severally, to:

• Reimburse ₹2,29,000 (Rupees Two lakh Twenty-Nine thousand only) to the complainant, with interest at 6% per annum from the date of filing of the complaint (October 23, 2024) until realisation.

• Pay ₹5,000 (Rupees Five thousand only) as compensation for mental agony and trauma.

• Pay ₹5,000 (Rupees Five thousand only) towards the costs of litigation.

Time for compliance was fixed at 45 days from receipt of the order. The bench comprised Smt Suvarna Jayasri (President), Sri Gajjala Venkateswarlu (Member) and Sri Makyam Vijay Kumar (Member). The complainant appeared party-in-person; the insurer was represented by advocate P. Bal Reddy.