Telangana commission upholds Rs 5.29 lakh claim against Care Health on non-disclosure plea

The Telangana State Consumer Disputes Redressal Commission on 23 October 2026 dismissed an appeal by Care Health Insurance and upheld an order to pay a 70-year-old policyholder Rs 5,29,024 for surgery, with 6% interest. The commission held that the insurer failed to show he had suppressed any material fact.

What Happened

According to the order, the policyholder first took health cover of Rs 5 lakh from Oriental Insurance in December 2015 and ported it to Care Health in January 2021, raising the sum insured to Rs 10 lakh. In July 2023 he underwent surgery in Hyderabad for prostate cancer and paid the hospital bill of Rs 5,29,024 himself after cashless treatment was refused. Care Health rejected the cashless request for non-disclosure of a pre-existing ailment, and later rejected his reimbursement claim on 18 October 2023 for not sending records of 2020 treatment.

The commission noted that the cancer was confirmed by a biopsy report of December 2021, after the Care Health policy began, so he could not have been expected to know of it. The proposal form had only five questions and none on symptoms or medication, and he had answered yes to the question on pre-existing disease. The insurer issued the policy without asking further, so it could not later plead suppression, the commission held.

It also said that on porting, the policyholder keeps his waiting-period credits, and the claim fell within the original Rs 5 lakh cover held since 2015. It rejected the insurer's new plea of a Rs 2.5 lakh cap on cancer treatment because that ground was not in the rejection letter or its reply.

The district commission's order of 3 April 2025 stands: Rs 5,29,024 with 6% interest from 22 July 2023, Rs 20,000 compensation and Rs 10,000 costs.

What It Means

The order says an insurer that accepts a proposal despite a yes to a pre-existing disease question, without asking more, cannot reject a claim for non-disclosure, and cannot add new grounds after the rejection letter. Policyholders who port a policy keep the benefit of years already covered. The order may be appealed. Complaints can be filed through e-Daakhil or the National Consumer Helpline on 1915.

Source: Consumer commission order