A district consumer disputes redressal commission has ordered an insurance company to pay Rs 9.95 lakh along with 9% interest from the date of the original claim for a health insurance policyholder whose claim remained pending for 16 years.
The complainant had submitted a health insurance claim for hospitalisation expenses in 2010, but the insurer repeatedly delayed settlement seeking additional documentation, then declared the claim 'time-barred' under limitation provisions.
The commission ruled that the insurer's own delay in processing the claim cannot be used as a defence against payment, citing the principle of 'estoppel'. The case highlights the importance of IRDAI's 30-day claim settlement norm and the escalation path available to policyholders.