Chandigarh, December 23, 2025 : The District Consumer Disputes Redressal Commission-II, U.T. Chandigarh has held Oriental Insurance Company Limited and Raksha Health Insurance TPA Private Limited guilty of deficiency in service and unfair trade practice for arbitrarily closing a valid mediclaim as “No Claim”, despite treatment records being available. At the same time, the Commission dismissed the complaint against Punjab National Bank, finding no lapse on its part.
The complaint was filed by Subhash Chander Jindal, a savings account holder with Punjab National Bank, who stated that on the persuasion of bank officials he had purchased a mediclaim health insurance policy issued by Oriental Insurance and administered through Raksha Health Insurance TPA. The policy, first taken in 2016, covered him and his family for a sum insured of ₹5 lakh and was continuously renewed, including for the period from 25 January 2019 to 24 January 2020.
During the currency of the policy, Jindal contracted dengue on 4 September 2019 and was admitted to Max Hospital, SAS Nagar, Mohali, from 8 to 13 September 2019. Despite informing the hospital of his mediclaim cover, he was denied cashless treatment and asked to deposit ₹10,000 at admission. He ultimately incurred medical expenses of ₹32,137.25 for the treatment.
The complainant lodged a reimbursement claim on 8 September 2019 and followed it up with a reminder in November the same year. According to him, despite submitting all required documents, the insurer and the TPA kept raising queries. By a letter dated 17 September 2020, the claim was eventually closed as “No Claim” on the ground that requisite documents had allegedly not been furnished.
Punjab National Bank argued before the Commission that it had no role in issuance, administration, processing or repudiation of the insurance policy. It submitted that mere payment of premium through the bank did not create any contractual liability regarding settlement of the claim. The Commission accepted this defence and held that no deficiency in service was established against the bank.
Oriental Insurance and Raksha Health Insurance TPA, on the other hand, contended that the claim was closed only because the complainant failed to submit documents despite repeated reminders. They denied any unfair trade practice or deficiency in service.
After examining the record, the Commission noted that it was undisputed that the complainant was insured during the relevant period and that his claim had been closed as “No Claim”. Crucially, the Commission relied on the insurer’s own letter dated 23 July 2020, which acknowledged that the claim papers had already been submitted to the TPA. Although the insurer referred to earlier letters allegedly sent by the TPA seeking additional documents, none of those letters were produced on record, leading the Commission to draw an adverse inference against the insurer and the TPA.
The Commission also observed that if the insurer and TPA were genuinely interested in deciding the claim, they could have independently obtained the treatment records from the hospital. It noted that most documents, including the discharge summary, bills and medical reports, were already part of the record and in the possession of the insurer. In such circumstances, there was no justification for denying a relatively small but genuine claim.
Holding that closing the claim as “No Claim” amounted to deficiency in service and unfair trade practice, the Commission partly allowed the complaint. Oriental Insurance Company Limited and Raksha Health Insurance TPA Private Limited were directed to reimburse ₹32,137.25 to the complainant along with interest at 9 percent per annum from 21 September 2022, the date of institution of the complaint, until realization. They were also directed to pay ₹10,000 as lump-sum compensation towards mental harassment and litigation expenses. The complaint against Punjab National Bank was dismissed.
The decision was delivered by a Bench comprising Amrinder Singh Sidhu, President, and Brij Mohan Sharma, Member, in Consumer Complaint No. CC/685/2022, Subhash Chander Jindal v. Punjab National Bank and Others, decided on 23 December 2025
