Pune: In a significant ruling, the Pune District Consumer Disputes Redressal Commission has directed Bajaj Allianz Insurance company to pay ₹19.21 lakh along with 7 per cent annual interest to a Pune resident after the insurer wrongfully denied reimbursement for emergency heart surgery conducted in the United States.
The commission strongly criticised the company for rejecting the claim on the grounds of pre-existing hypertension, noting that “hypertension and diabetes are lifestyle disorders, not diseases,” and therefore not sufficient grounds to dismiss a medical claim.
The order was passed by Commission President Anil Javalekar and members Sarita Patil and Shubhangi Dunakhe, in favour of complainant Anil Supnekar, a resident of Mukund Nagar, Pune. Supnekar was represented by Advocate Dnyanraj Sant.
According to the case details, Supnekar had travelled to the United States in February 2020 to visit his children. Before his departure, he purchased a USD 50,000 overseas mediclaim policy valid for five months from Bajaj Allianz Insurance. However, the global outbreak of COVID-19 led to the suspension of international flights, forcing him to extend his stay in the US.
In view of this, Supnekar renewed the insurance policy every six months and paid additional premiums accordingly. During his extended stay, he required medical treatment for dental and dermatological conditions, for which the insurance company Bajaj Allianz did not provide reimbursement.
The situation worsened when Supnekar suffered a heart attack while still in the US and had to undergo an emergency angioplasty procedure at Stanford Healthcare. Despite submitting the claim, the insurer denied reimbursement, stating that the heart attack was caused by pre-existing hypertension.
Bajaj Allianz Insurance Company Decision Challenged
Challenging this decision, Supnekar approached the Pune Consumer Commission, which found the insurer’s (Bajaj Allianz) reason invalid. The commission emphasised that such conditions are not diseases but lifestyle-related disorders, and cannot be used as grounds to reject emergency medical claims.
Accordingly, the commission has directed the insurance company to pay ₹19,21,000 towards medical expenses incurred, along with 7% annual interest from the date of the claim until final payment.
