Punjab commission orders Care Health to pay Rs 5 lakh on rejected cancer claim

The State Consumer Disputes Redressal Commission, Punjab, has upheld an order directing Care Health Insurance Limited to pay Rs 5 lakh with interest on a rejected cancer treatment claim. In its decision of 14 October 2026, the commission also upheld a separate order that the insurer must renew the family's health policy.

What Happened

A policyholder and his family were covered under a group mediclaim policy, with Punjab Gramin Bank as the master policyholder, from 11 November 2022 to 10 November 2023. His wife was treated for cancer at a New Delhi hospital at a cost of Rs 5,33,664. Care Health declined the cashless request, saying she had not disclosed a pre-existing breast cancer from 2017.

The District Consumer Disputes Redressal Commission, Amritsar, ordered the insurer on 12 July 2024 to pay the sum insured of Rs 5 lakh with 7% annual interest from the date of the complaint, Rs 20,000 compensation and Rs 10,000 litigation costs.

The state commission held that the insurer relied only on a line in the hospital discharge summary and produced no medical records of any earlier treatment. It said a patient history noted in hospital papers is not proof of concealment unless its source is shown. It also held that the earlier breast cancer and the present illness were unrelated, and that the policy's own definition treats a condition as pre-existing only if diagnosed or treated within 48 months before the policy began, a period that had passed. The insurer's appeal was dismissed and the amounts it deposited, with any interest, are to be released to the policyholder.

In a second appeal, the commission held that the insurer could not refuse to renew the policy on the same non-disclosure ground that had already been found unjustified.

What It Means

For health insurance buyers, the ruling shows that an insurer rejecting a claim for non-disclosure must prove it with medical evidence, not just a note in a discharge summary. It also shows that the policy's own look-back period for pre-existing diseases matters, and that a rejection found unjustified cannot be used to deny renewal. This is the commission's finding and may be appealed. Policyholders facing a claim rejection can use the National Consumer Helpline (1915) or e-Daakhil.

Source: Consumer commission order