Insurer Told to Pay Claim After Failing to Prove Client's BP History
'A pre-existing disease or concealment of medical history cannot be established unless the insurer produces medical records proving the condition existed before the policy was taken'
UdaipurTimes, Oct 20, 2026 - In a notable ruling on a health insurance claim, a Central District Consumer Disputes Redressal Commission in Delhi has ruled against an insurance company for unfairly denying a senior citizen’s claim. The Commission observed that a pre-existing disease or concealment of medical history cannot be established unless the insurer produces medical records proving the condition existed before the policy was taken.
Claimant Yashpal Behl had purchased a group medical insurance policy worth Rs 7.5 lakh for himself and his wife. In 2021, he was hospitalised, incurring medical expenses of approximately Rs 4.71 lakh. The insurance company rejected his claim, alleging that Behl had been suffering from high blood pressure (BP) for four years and had concealed the condition when purchasing the policy. The company subsequently cancelled the policy as well.
The Commission observed that the insurer had failed to produce any official medical records establishing that Behl had a pre-existing history of high BP. The insurance firm was directed to pay the rejected claim of Rs 4.71 lakh, along with 6% interest. Additionally, the insurance company was ordered to pay Rs 25,000 as compensation for mental harassment and Rs 15,000 towards litigation expenses.
Source: Media Reports
