Chandigarh commission upholds Rs 5.19 lakh health claim against Aditya Birla Health
The Chandigarh State Consumer Commission dismissed Aditya Birla Health Insurance's appeal, upholding an order to pay Rs 5.19 lakh and restore a policy it cancelled over a 2012 medical history.
Key points
- The Chandigarh State Consumer Disputes Redressal Commission dismissed Aditya Birla Health Insurance's appeal on 27 October 2026.
- The insurer must pay Rs 5,18,589 with 9% interest, Rs 30,000 in compensation and costs, and restore the cancelled policy.
- The commission held that a 2012 medical episode fell outside the policy's 48-month pre-existing disease definition; the order may be appealed.
Photo: Dominic / Wikimedia Commons, CC0 1.0 (cropped). Representational image.
The State Consumer Disputes Redressal Commission, U.T. Chandigarh, on 27 October 2026 dismissed an appeal by Aditya Birla Capital Health Insurance Company and upheld an order to pay a policyholder Rs 5,18,589 for cancer treatment. The commission held that the insurer wrongly rejected the claim and cancelled the policy over a medical episode from 2012.
What Happened
According to the order, the policyholder had been insured with the company since 1 April 2021 for a sum insured of Rs 20 lakh. In 2023 he spent Rs 1,61,454 on surgery at PGIMER, Chandigarh and Rs 3,57,135 on further treatment at Max Super Speciality Hospital, Mohali. The insurer rejected the claim, saying he had not disclosed seizures and a brain lesion dating to 2012, and later cancelled the policy.
The commission noted that the policy itself defines a pre-existing disease as a condition diagnosed or treated within 48 months before the policy began. The 2012 episode was more than eight years earlier. It relied on a treating doctor's certificate that there was no definite basis to say the 2023 tumour had persisted since 2012, and held that the insurer had not proved that a material fact was deliberately hidden. It said the principle of utmost good faith cannot be used to override the policy's own definition.
The commission upheld the district commission's order of 1 April 2026: Rs 5,18,589 with 9% simple interest from the date the complaint was filed, Rs 20,000 as compensation, Rs 10,000 as litigation costs, and restoration of the policy on the same terms on payment of the due premium. That order set 45 days to comply, after which interest rises to 12%.
What It Means
The order says an insurer relying on non-disclosure must show the condition falls within the policy's own pre-existing disease definition and that it was knowingly hidden, and that cancelling a long-running policy on that ground can be reversed. Policyholders whose claims are rejected can check the definitions in their policy wording. The order may be appealed. Complaints can be filed through e-Daakhil or the National Consumer Helpline on 1915.
Source: Consumer commission order
Sources & Citations
- Consumer commission order — Consumer commission