The Mumbai suburban additional district consumer dispute redressal commission ruled in favor of Asha Zaveri, a resident of Bhandup, ordering M.pal Cigna Health Insurance Company to reinstate her health insurance policy and compensate her Rs 3 lakh for mental agony, along with Rs 20,000 in litigation charges. The Goregaon-based insurance company had allegedly terminated Zaveri’s policy without justification, despite receiving her premium payment on time.

In her complaint, Zaveri stated that she had initially purchased the Pro-Health-Protect Policy in 2019 through an advertisement on Policybazaar.com, renewing it annually thereafter. For the 2021-2022 period, Zaveri paid a premium of Rs 12,961.09 on June 16, 2021, via Google Pay, well before the due date of June 23, 2021. She received an email confirmation of her policy renewal and later contacted the insurer to avail a health check-up benefit under the policy. However, she was informed that her renewal was rejected, as the payment was allegedly made via a credit card, which the insurer claimed was unacceptable. Zaveri countered that she did not own a credit card and that her bank statement clearly showed the transaction was successful.

In response to her queries, Zaveri received conflicting statements from company representatives—some confirming the policy’s active status, while others claimed it was inactive, delaying her access to the health check-up benefit. Finally, on November 3, 2021, she received an email from M.pal Cigna informing her that her policy renewal had been terminated.

Seeking clarification, Zaveri verified with her bank, which confirmed that the premium payment was successfully credited to the insurance company’s account. Frustrated by the insurer’s inconsistency and lack of resolution, she took her complaint to the Consumer Commission.

In its defense, M.pal Cigna denied all allegations, asserting that Zaveri had not made sufficient efforts to pay the premium on time, leading to policy termination. However, the Commission, after reviewing all evidence, found the insurer’s actions “illegal and arbitrary,” and ruled that the termination was baseless. The Commission further clarified that Zaveri had not made any claims under the policy since inception, nor was there any fraud, misrepresentation, or nondisclosure of material facts on her part.

In its final order, the Commission directed M.pal Cigna Health Insurance to reinstate Zaveri’s policy, allowing her to resume coverage by paying any outstanding premiums and applicable charges. 

Rahul Dev

Cricket Jounralist at Newsdesk

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