NEW DELHI: A Punjab district consumer commission, in an order dated July 22, directed Star Health and Allied Insurance to reimburse a woman's medical claim after it rejected expenses incurred on her son's dengue treatment, citing alleged discrepancies in hospital records. The commission held that the insurer failed to verify those discrepancies with the hospital and wrongly rejected a genuine claim.

Why was the dengue insurance claim rejected?According to the commission's order, the complainant had been covered under Star Health's Family Health Optima Insurance Plan since November 2020. During the policy period, her son was admitted to Dhaliwal Child Care Centre, Moga, with dengue on November 1, 2025, and remained hospitalised until November 6. As the insurer advised her not to wait for cashless approval, she paid the hospital bill of Rs 22,751 from her own pocket.

After her son was discharged, she submitted a reimbursement claim. However, the insurance company rejected it on November 29, 2025, stating that there were discrepancies in the medical records which amounted to misrepresentation under the policy terms.

The woman approached the District Consumer Disputes Redressal Commission, Moga, seeking reimbursement of the hospital expenses along with compensation for mental harassment and litigation costs.

However, the insurance company argued that the hospital records contained several deficiencies, including the absence of a vital chart, progress notes, intake-output chart, proper payment receipt and UHID/IPD number on the discharge summary. It claimed these discrepancies justified rejection of the claim under the policy conditions.

Commission order the insurance company to pay Rs 26,882The bench comprising President

Priti Malhotra and members

Mohinder Singh Brar and

Aparana Kundi found that the discrepancies pointed out by the insurer related to hospital records, which were prepared by the hospital and were beyond the complainant's control. It also noted that these grounds were not even mentioned in the repudiation letter issued to the complainant.

"We are of the considered view that all the discrepancies as mentioned above seems highly absurd and are beyond the control of the complainant... Further, the said discrepancies are not mentioned in the repudiation letter dated 29.11.2025 issued by Opposite Parties, so the same are not maintainable," the commission held.

The commission also observed that if the insurer genuinely doubted the hospital records, it should have verified the documents with the hospital before rejecting the claim. However, it found no evidence that the company had made any such effort.

"Had the Opposite Parties get verified from the hospital concerned about the discrepancies... then they would have been justified in repudiating the claim... However, there is no document showing that it ever get verified from the hospital concerned," the bench noted.

The commission further held that the insurer had failed to prove any wrongdoing by the complainant and that the medical treatment was genuine. It noted that the company itself had assessed the admissible claim amount at Rs 21,882.

"Thus, in our considered opinion, the claim of the complainant for the reimbursement of the medical expenses... is genuine and payable by the Opposite Party-Insurance Company. By rejecting the genuine claim of the complainant, opposite parties are found deficient," it further added.

Holding the insurer guilty of deficiency in service, the commission directed it to pay Rs 21,882 towards the medical claim and Rs 5,000 towards compensation and litigation expenses, taking the total award to Rs 26,882. It also directed the company to comply with the order within 30 days, failing which it would have to pay an additional Rs 3,000.