Coimbatore: The Coimbatore District Consumer Disputes Redressal Commission has directed a private insurance company to pay compensation of ₹32 lakh with 9% interest to a consumer for denying a medical insurance claim..
According to an official source, Mohan Karupannan from Karur district planned a tour to Japan in March-April 2023. As part of his travel arrangements, he opted for travel insurance, including medical coverage, from ICCI Lambaord General Insurance Company in Coimbatore.
While on tour in Japan, on April 1, 2023, he suffered an ST-elevation myocardial infarction (STEMI), a type of heart attack, and was admitted to a hospital there. He incurred medical expenses amounting to ₹32.09 lakh for treatment. After returning to India on April 16, he submitted medical expenses claim to the insurance company along with all necessary documents.
However, the insurance company rejected his claim on the grounds that the STEMI occurred due to his pre-existing conditions of hypertension and diabetes, according to a source.
Subsequently, Mohan Karupannan filed a petition with the Coimbatore District Consumer Disputes Redressal Commission, stating that he was never hospitalised for hypertension or diabetes before. He contended that having diabetes or high blood pressure does not necessarily lead to a heart attack, and there was no medical evidence to prove that his STEMI was caused solely by his pre-existing conditions.
In its order, the commission—comprising president R Thangavel and members P Marimuthu and G Suguna—ruled that hypertension alone is not the sole cause of STEMI. The commission held that rejecting the claim without valid medical evidence constituted a deficiency in service.
As a result, the commission directed the insurance company to pay ₹32 lakh for medical expenses along with 9% interest, ₹10,000 for mental agony, and ₹5,000 towards the cost of proceedings.