Gurgaon District Commission Holds Apollo Munich Health Insurance Liable For Wrongfully Repudiating Genuine Medical Claim

The District Consumer Disputes Redressal Commission, Gurgaon (Haryana), comprising Sanjeev Jindal (President), Jyoti Siwach, and Khushwinder Kaur (Members), held Apollo Munich Health Insurance accountable for wrongfully repudiating a medical claim. \r

The case involved the Complainant's wife, who was hospitalized at Medanta Hospital, Gurugram, for lower abdomen pain and bleeding. Despite informing the insurer and undergoing necessary investigations as part of her treatment, Apollo Munich rejected the claim citing an exclusion clause for investigations alone. \r

Citing precedents emphasizing the integral role of investigations in treatment, the Commission deemed the rejection illegal and arbitrary. It ordered Apollo Munich to reimburse Rs. 54,257/- for medical expenses and awarded Rs. 25,000/- as compensation along with Rs. 11,000/- for litigation costs.