Noida: District consumer commission has directed Star Health and Allied Insurance to settle a mediclaim pending for the past four years of Rs 1.2 lakh with 6% interest calculated from the date of filing of the complaint in March 2023 and pay Rs 5,000 in litigation costs within 30 days.The commission ruled that an insurer cannot reject a policyholder’s claim on grounds of a pre-existing condition unless it can prove, with evidence, that the buyer was aware of the ailment and deliberately concealed it at the time of buying the policy. Rejection without sufficient evidence, the commission said, amounts to deficiency in service and unfair trade practice.Kamlesh Choudhary had filed a complaint with the commission against the insurer and Punjab National Bank, Greater Noida, on March 27, 2023. She told the members that the bank had facilitated her in buying a policy with Star Health and Allied Insurance in April of the preceding year. It had coverage of Rs 5 lakh. However, on June 8 that year, she experienced acute vomiting and diarrhoea and was admitted to Kailash Hospital, where she was diagnosed with a liver ailment.The hospital handed her a bill of Rs 1.2 lakh and emailed the insurance company seeking approval. However, the company denied the claim. The hospital was unable to provide the patient’s previous records related to the illness, stating that she had not previously experienced any problem and had not been treated earlier. She was forced to pay the entire hospital bill.The insurance company, however, denied the allegations. It said that Choudhary had bought the policy and it gave coverage of Rs 5 lakh for her entire family. It said that she had filed for reimbursement within two months of buying the policy and it was valid during her admission at the hospital. She, however, had failed to disclose that she had a history of type 2 diabetes mellitus. Moreover, her discharge summary indicated that Choudhary had been diagnosed with acute viral enteritis, a type of stomach or gut inflammation caused by a virus and occasionally accompanied by thrombocytopenia (a low platelet count). “Her ultrasound report also revealed chronic kidney disease,” the insurance company told the forum. “After examining the documents submitted by her, it was determined that the documents were insufficient to settle the claim.”The commission dismissed the complaint against Punjab National Bank, and commission president Anil Kumar Pundir and member Anju Sharma on Oct 13 ruled that an insurance company cannot reject a claim because the policyholder did not disclose pre-existing illnesses at the time of buying the policy.The commission concluded that the fact that type 2 diabetes mellitus or another medical condition was mentioned during treatment is not sufficient to prove the intentional non-disclosure of a prior illness unless they prove it with evidence. It asked the insurer to settle the claim.