Haryana consumer commission orders insurer to pay $90,000 for heart treatment claim

A consumer commission in Haryana ordered Care Health Insurance to pay the remaining $90,000 of a travel insurance claim to a 73-year-old woman for heart treatment in the US, rejecting the insurer's decision to limit payment to 10 percent based on her disclosed diabetes. The insurer had paid only $9,900 of the $100,000 policy, citing diabetes as a risk factor for the heart attack. The commission found the insurer accepted the risk and premium with full knowledge of the condition, and no medical evidence linked diabetes to the heart attack. It also ruled the complaint was maintainable after the Ombudsman dismissed it for exceeding its financial limit. The commission deemed the claim reduction a deficiency in service and unfair trade practice, awarding the remaining amount with 9 percent annual interest from March 2022, plus Rs 1 lakh for mental agony and Rs 22,000 for legal costs. The order must be complied with within 45 days, with interest rising to 12 percent if delayed.