Consumer Commission Rules Against Star Health Insurance
The North District Consumer Commission in Chennai has directed Star Health Insurance to pay ₹2,35,897.92 to a policyholder after wrongly rejecting a medical claim. The commission held that the insurer's repudiation amounted to a deficiency in service and ordered 9% annual interest from May 7, 2025, the date of rejection.
Case Details
The complainant, T Poongavanam, an employee covered under a group health insurance policy from her employer Micro Macro Quality Engineering Services, filed the case. Her husband, N Tamilarasan, was admitted to Gleneagles Global Health City, Perumbakkam, in June 2023 with persistent chest pain, breathing difficulties, fever, and pleural effusion. During a four-day hospital stay, he underwent procedures including pigtail insertion and biopsy.
The insurer denied cashless treatment and later rejected the reimbursement claim, citing a policy exclusion for admissions primarily for investigation and evaluation. The family spent nearly ₹2.36 lakh on hospitalization and follow-up care.
Commission's Observation
The commission noted that the complainants had previously approached the consumer forum, after which the insurer agreed to reconsider the claim upon fresh documents. However, the claim was again rejected on the same grounds. The commission ruled that the rejection was unjustified and ordered compensation with interest.
