Non-payment of interest and short payment of claim after Insurance Ombudsman Award No. IO/CHN/A/HI/0629/2026-2027 (Niva Bupa Policy 31014380)

Mathavaraj, held Niva Bupa (formerly Max Bupa) Health Insurance Policy No. 31014380 (Member ID 7620653) for the period 31.08.2019 to 30.08.2021, with a sum insured of ₹5,00,000 and a premium of ₹14,138. The complainant was hospitalised at SIMS Chellum Hospital from 01.02.2020 to 14.02.2020 for a recurrent ischemic stroke. He claimed ₹1,88,159 (Claim ID 519257). The insurer's own statement at the Ombudsman hearing was that the claim was filed on 21.03.2020. The insurer repudiated the claim, alleging non-disclosure of pre-existing hypertension (clauses 5.1 and 10.21), and cancelled the policy. The repudiation was upheld by its GRO on 21.01.2026 and again by notices dated 04.07.2026 and 08.07.2026. The complainant approached the Insurance Ombudsman, Chennai (Complaint No. CHN-H-[protected]). By Award No. IO/CHN/A/HI/0629/2026-2027 dated 30.09.2026, the Ombudsman held that the pre-existing disease contention had no force. The Ombudsman directed the insurer to settle the claim as per the bills submitted and to restore the cancelled policy with all continuity benefits. The insurer paid only ₹1,72,846 on 27.10.2026 (NEFT UTR AXISCN[protected]), which is ₹15,313 less than the claimed amount. No itemised explanation for the deduction was given. The insurer later said the payment was "subject to policy deductibles", although the Award contains no such direction. No interest was paid for the delay of more than six years from the date the claim was filed, although the claim was wrongly denied. Under the IRDAI Protection of Policyholders' Interests Regulations, interest is payable on delayed claim settlement. The complainant sent a notice dated 13.10.2026 (SR 28284142) to the insurer's GRO and Managing Director, with copies to the Ombudsman and IRDAI. The insurer replied under Case ID 28392700 without paying the interest or the shortfall. This amounts to deficiency in service and an unfair trade practice. The complainant has suffered financial loss and mental agony from the prolonged denial after a stroke. Relief sought (a) Payment of the shortfall of ₹15,313, with an itemised explanation of any deduction. (b) Interest on the claim amount from the date of the claim to the date of payment, at the IRDAI rate (approximately ₹____ up to 27.10.2026), with further interest till realisation. (c) Compensation of ₹1,00,000 for mental agony and harassment. (d) Litigation costs of ₹____. (e) Written confirmation that Policy 31014380 has been restored with continuity benefits, as directed by the Award.