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Bengaluru man wins legal battle against health insurer, secures ₹71,000 claim and premium refund: Report
In its final order, the commission directed Redkenko to pay a total of ₹86,972 ( ₹71,000 + ₹15,972) along with 6% interest to the customer.
A Bengaluru resident, whose health insurance claim of ₹71,000 was rejected, has secured justice from the city’s II Additional District Consumer Disputes Redressal Commission, reported The Times of India. The commission recently directed the insurance company to settle the claim and refund ₹15,972 that the complainant had paid for another policy, which was later denied.
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How the issue unfolded?
According to the report, Umesh C, a 36-year-old resident of Kempegowda Layout, Laggere, had purchased a family insurance plan from Redkenko Health Tech Pvt Ltd. The company assured him that the policy would cover ten days of hospitalisation along with 50% of outpatient department (OPD) expenses. However, when he required hospitalisation on April 16 and 17, 2024, his claim for ₹71,000 was outrightly rejected.
Additionally, Umesh had reportedly paid ₹15,972 as a premium for a separate plan, which was supposed to provide 100% coverage on medicines, consultations, and hospitalisation expenses up to ₹20 lakh for his family. However, citing "health score issues," the insurer denied the renewal and initially agreed to refund the amount—yet, the refund never arrived.
With no resolution in sight, Umesh escalated the matter to various authorities, including the National Consumer Forum, Insurance Regulatory and Development Authority (IRDAI), the RBI ombudsman, and JC Nagar police. When he attempted to visit the company’s Bengaluru office, he found it closed.
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Left with no choice, he sent a legal notice to Redkenko’s Mumbai headquarters and Bengaluru regional office on June 10, 2024. However, after receiving no response, he formally filed a complaint with the consumer forum on July 11, 2024, citing "deficiency in service." Despite multiple notices, the insurance company did not appear before the commission to defend itself.
After reviewing transaction records, hospital bills, and policy documents, the consumer commission ruled in Umesh’s favor, stating that Redkenko had misled customers with false promises and deceptive advertisements. The commission noted that the insurer had collected premiums with assurances of coverage, only to deny claims when customers sought benefits.
In its final order, the commission directed Redkenko to pay Umesh a total of ₹86,972 ( ₹71,000 + ₹15,972) along with 6% interest from the date of complaint until the payment is made. Additionally, the insurer was ordered to compensate him with ₹10,000 for mental distress and legal expenses.
