Northwest Delhi District Commission Holds United India Insurance Co Liable For Wrongful Repudiation Of Genuine Medical Claim

In a recent case, the District Consumer Dispute Redressal Commission-V, Northwest Delhi, found United India Insurance Company liable for deficient service. The complainant, covered under a mediclaim policy since 2009, incurred medical expenses of Rs. 1,97,184/- for coronary angioplasty at Saroj Hospital. \r

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Despite the policy's coverage of up to Rs. 2 lakh, the Insurance Company reimbursed only Rs. 40,000/-, citing policy clause 1.2(d) limiting reimbursement for certain surgeries. The District Commission ruled the partial reimbursement unjustified and arbitrary, noting the Insurance Company's failure to fully honor the claim within policy limits. It ordered the Insurance Company to pay 70% of the total bill (after deducting Rs. 40,000/-) with 6% interest per annum and awarded Rs. 15,000/- as compensation to the complainant.