Bengaluru man buys health insurance for parents, pays premiums for three years, mother undergoes treatment but insurer rejects claim, gets relief in consumer court

A Bengaluru man who spent Rs 3.13 lakh on health insurance policies for his parents challenged Star Health and Allied Insurance Company's handling of his mother's medical claim after she underwent endoscopy and colonoscopy procedures for digestive problems. He alleged that the insurer rejected the claim by classifying the procedures as investigative rather than therapeutic, despite receiving supporting medical records.

In the order dated October 9, 2026, the matter was heard by Bangalore I Additional District Consumer Disputes Redressal Commission, comprising President Sri Syed Anser Kaleem and members Jyothi N and Renukadevi Deshpande.

Man spends Rs 3.13 lakh on parents' insurance

According to the complaint, H S Niranjan Rao purchased Star Health's Senior Citizens Red Carpet Insurance Policy on August 17, 2020, for a premium of Rs 1,67,329. The policy, which ran for three years, was intended to provide medical coverage for his parents. The complaint stated that no claims had been filed during the initial policy period.


Rao renewed the policy for another year on August 16, 2023, paying Rs 58,587. He also purchased two additional health insurance policies in July 2023, one for each parent, at Rs 43,865 per policy.

His total expenditure on the policies amounted to Rs 3,13,646, according to the complaint. He said the insurance was purchased to safeguard his parents against medical expenses.

Mother's digestive problems lead to medical procedures

The dispute began after Rao's mother, Renuka Rao, developed severe digestive problems on December 1, 2023. Her symptoms included vomiting, stomach pain and poor digestion.

Her general physician referred her to a senior gastroenterologist at a Multispeciality Hospital in Mysore. She underwent endoscopy and colonoscopy procedures as day-care treatments, followed by medication and a prescribed diet on December 28, 2023.

Rao submitted hospital bills, discharge summaries, biopsy reports and prescriptions to Star Health on December 29, 2023, as part of the claim process.

According to his complaint, the insurer rejected the claim on February 14, 2024, citing a policy exclusion and describing the procedures as investigative rather than therapeutic.

Rao disputed this classification, arguing that the policy covered eligible day-care procedures required for diagnosis and treatment. He subsequently resubmitted the documents, including additional discharge summaries and letters from the treating doctor explaining the medical purpose of the procedures.

Policyholder alleges repeated requests for documents

Rao alleged that Star Health continued to raise queries and seek documents even after he had submitted the medical records multiple times.

He claimed that he visited the insurer's office in person and communicated through email, but the dispute remained unresolved. According to his complaint, the insurer continued to cite missing documents despite earlier submissions.

Rao also alleged that the insurer maintained its position after the matter was taken to the Insurance Ombudsman. He argued that the repeated requests and failure to settle the claim amounted to deficiency in service under the Consumer Protection Act, 2019.

These are allegations recorded in the complaint and form part of the policyholder's case against the insurer.

Insurance Ombudsman identifies Rs 27,921 in expenses

Rao approached the Insurance Ombudsman on May 6, 2024, seeking resolution of the dispute.

According to the complaint, the Ombudsman issued a communication on June 26, 2024, identifying Rs 22,136 towards hospitalisation expenses and Rs 5,785 towards pre-hospitalisation expenses. Together, these amounts totalled Rs 27,921.

Rao alleged that Star Health failed to settle the claim fully despite the intervention. His complaint referred to Rs 50,734 as the amount he said was payable under the policy.

He sought payment of the remaining Rs 7,592.80, along with interest at 18% per annum from the date of claim submission. The complaint also sought Rs 5 lakh as compensation for mental agony, harassment and financial distress, besides Rs 50,000 towards litigation costs.

What the consumer commission order records

The complaint was filed on February 24, 2025, under Section 35 of the Consumer Protection Act, 2019. The commission's order dated October 9, 2026, records the dispute and the relief sought by Rao against Star Health.

For consumers dealing with similar disputes, retaining policy documents, claim forms, hospital bills, discharge summaries, prescriptions, doctors' explanations and written correspondence with the insurer can help establish the basis of a claim.