76-year-old woman denied insurance claim over clerical error, wins Rs 4.5 lakh payout

A Delhi District Consumer Commission ruled in favor of a 76-year-old senior citizen who had been denied an insurance claim due to a clerical error. The company was ordered to pay Rs 4.5 lakh - Rs 3.87 lakh for the refused cashless treatment and Rs 50,000 for harassment and Rs 35,000 for litigation expenses. The error concerned a mistake in recording the insured's kidney disease in her hospital files, which was corrected before her discharge.

The insurance company had repeatedly requested additional documents, including a separate affidavit from an emergency doctor, despite being provided with corrected medical records and a clarification letter from her treating doctor. The commission found that the insurer had failed to process the claim fairly, reasonably, and diligently, resulting in a financial burden for the senior citizen.