Kyphoscoliosis is deformity, not disease: Consumer commission upholds ₹7.25L payout

Dehradun: State Consumer Disputes Redressal Commission has upheld the relief granted to a widow, ruling that kyphoscoliosis is a deformity rather than a disease and that there was no evidence of prior consultation or treatment to suggest concealment of a material fact.Confirming deficiency in service by the insurer for denying cashless treatment and reimbursement, the commission on March 16, 2026, directed compensation of Rs 7.25 lakh -- the total sum insured under the policy – along with 6% annual interest from May 2, 2019, till payment and Rs 5,000 towards legal expenses.The case relates to a Family Health Optima Insurance Plan covering Navpreet Jain, his wife, Mani Jain, and their two children for the period March 30, 2018, to March 29, 2019. Jain fell ill on Jan 30, 2019, and was admitted to a New Delhi hospital and died on Feb 14, 2019.Hospital bills totalled Rs 8,27,584, but the insurer declined cashless approval and later repudiated the claim.Star Health argued that Jain had concealed a pre-existing condition, citing a Feb 8, 2019, rejection letter claiming he had suffered from kyphoscoliosis since age 12 and had not disclosed it in the proposal form.The state commission found the repudiation unjustified, saying it constituted deficiency in service. It held that the insurer's liability cannot exceed the insured sum, reducing the district commission's award of full treatment cost to Rs 7.25 lakh, while affirming the rest of Dec 26, 2020, order.