The District Consumer Disputes Redressal Commission has directed ManipalCigna Health Insurance to reimburse ₹50,700 to a policyholder whose cataract claim it had rejected, holding that the insurer failed to establish that a previous eye condition was linked to the ailment for which the claim was made.
The commission also ordered the insurer to pay 9% annual interest on the amount from January 31, 2026, when it rejected the claim, until payment. It awarded ₹15,000 to the complainants for mental agony, harassment and litigation expenses.
Gagan Singh of Sector 61, Phase 7, Mohali, and his mother, Pritam Kaur of Jandwala, Ferozepur, had filed the complaint against the insurer under the Consumer Protection Act, 2019. Gagan obtained a ProHealth group insurance policy (family floater) covering his parents, including Pritam Kaur and her husband, Avtar Singh.
Kaur underwent cataract extraction with intraocular lens implantation in her left eye on December 11, 2025, for an immature cataract. The family submitted a reimbursement claim to the insurer after paying ₹50,700 for the treatment.
The insurer rejected the claim on January 31, 2026, citing Kaur’s medical history of penetrating keratoplasty (PKP) and astigmatism dating back to May 16, 2013. It argued that she had not disclosed the previous conditions when obtaining the policy and that they were relevant to the present eye ailment.
{{/usCountry}}The insurer rejected the claim on January 31, 2026, citing Kaur’s medical history of penetrating keratoplasty (PKP) and astigmatism dating back to May 16, 2013. It argued that she had not disclosed the previous conditions when obtaining the policy and that they were relevant to the present eye ailment.
{{/usCountry}}The complainants told the commission that the earlier treatment concerned Kaur’s right eye, while the cataract surgery involved her left eye. They argued that the two conditions were unrelated.
After examining the medical records, the commission found that the earlier treatment did concern the right eye, while the December 2025 surgery involved the left eye. It said the insurer had not produced medical evidence showing that the earlier PKP or astigmatism was connected to the cataract or affected the treatment.