Insurer fined for rejecting claim, to pay over Rs.65k
Mohali, Sept. 21 -- The District Consumer Disputes Redressal Commission has directed ManipalCigna Health Insurance to reimburse Rs.50,700 to a policyholder whose cataract claim it had rejected, holding that the insurer failed to establish that a previous eye condition was linked to the ailment for which the claim was made.
The commission also ordered the insurer to pay 9% annual interest on the amount from January 31, 2026, when it rejected the claim, until payment. It awarded Rs.15,000 to the complainants for mental agony, harassment and litigation expenses. Gagan Singh of Sector 61, Phase 7, Mohali, and his mother, Pritam Kaur of Jandwala, Ferozepur, had filed the complaint against the insurer under the Consumer Protection Act, 2019. Gagan obtained a ProHealth group insurance policy (family floater) covering his parents, including Pritam Kaur and her husband, Avtar Singh.
Kaur underwent cataract extraction with intraocular lens implantation in her left eye on December 11, 2025, for an immature cataract.
The insurer rejected the claim on January 31, 2026, citing Kaur's medical history of penetrating keratoplasty (PKP) and astigmatism dating back to May 16, 2013. After examining the medical records, the commission found that the earlier treatment did concern the right eye, while the December 2025 surgery involved the left eye....
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