A district consumer dispute redressal commission in Kerala has ordered a private insurance company to pay $3,67,849 to a client after his insurance claim was denied, alleging that he had concealed a pre-existing health condition, commission officials said.

In its recent order, the Ernakulam District Consumer Disputes Redressal Commission directed Star Health and Allied Insurance Company to pay $3,67,849 to the client, commission authorities said.

The Commission’s ruling comes in response to a complaint filed by KP Rendeep, a resident of Aluva in Ernakulam district, who underwent aortic valve replacement surgery at a private hospital.

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Rendeep joined Star Health’s Health Optima insurance plan in 2018 and incurred surgery expenses totaling $3,07,849.

Star Health Insurance argued that the plaintiff’s condition existed before purchasing the policy and that he had concealed this information. The insurer also maintained that the policy did not cover expenses related to pre-existing conditions during the first two years.

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However, the commission, headed by chief justice DB Binu along with members V Ramachandran and TN Sreevidhia, ruled that rejection of the claim without clear evidence or proper communication violated trust between the insurer and the customer. The commission stated that such actions could not be allowed to stand.

In addition to the treatment costs, the commission ordered the insurance company to pay $50,000 as compensation and $10,000 for legal costs within a period of 30 days.