Medak Consumer Commission Orders IFFCO Tokio to Pay ₹1.58 Lakh for Rejected Health Claim
SANGAREDDY: The District Consumer Disputes Redressal Commission, Medak, has directed IFFCO Tokio General Insurance Company Ltd to pay ₹1,58,122 with 9% annual interest to a policyholder whose health insurance claim was repudiated. The commission held that the insurer’s rejection amounted to deficiency in service.
The order, delivered on October 13, 2025, by a bench comprising president Suvarna Jayasri and members Gajjala Venkateswarlu and Makyam Vijay Kumar, partly allowed the complaint filed by Patlolla Madhusudhan Reddy, 61, a businessman from Plavancha in Tekmal mandal.
Reddy had obtained a family health protector policy (No. H1334359) from IFFCO Tokio, valid from December 23, 2023, to December 22, 2024, for himself and his wife Munnemma, by paying ₹24,143 as premium. He was hospitalised at Russh Super Speciality Hospital, Suchitra Circle, Hyderabad, from March 14 to 17, 2024, for abdominal and chest pain.
According to the complaint, a representative of the insurer visited the hospital, assured cashless settlement, collected documents, and promised payment within three days. However, the company later issued a letter dated May 17, 2024, repudiating the claim under “Exclusion 11”, stating that Russh Hospital was in the list of excluded providers.
IFFCO Tokio, in its defence, said the claim was non-admissible as per policy conditions because the hospital was on its excluded list and argued there was no deficiency of service.
After examining documents and depositions from both sides, the commission noted that the policy was valid and the insurer’s representative had assured settlement. “The complainant had a valid policy and was entitled to the benefit. Rejection on technical grounds after giving assurance amounts to deficiency of service and unfair trade practice,” the order stated.
The panel directed IFFCO Tokio to pay ₹1,58,122 with interest at 9% per annum from May 17, 2024, until realisation, ₹10,000 as compensation for mental agony, and ₹5,000 as litigation costs. The insurer was given 40 days to comply.
