Reji John is an ordinary cab driver from Ernakulam in Kerala who has emerged victorious in a David versus Goliath battle against Star Health And Allied Insurance Company Limited, a major health insurance company in India. His relentless fight for rightful healthcare coverage has not only changed his life but also set a precedent for countless others facing similar struggles.
This 52-year-old native of Meenpara, Puthencruz decided to fight against the insurance company after he was denied the cashless facility for his treatment at an empanelled hospital of the insurance firm where he was admitted in critical condition due to Dengue and Covid in 2021.
Reji won a favourable judgment from the District Consumer Disputes Redressal Commission, Ernakulam, which ordered Star Health to pay a compensation of Rs 46,203 as reimbursement of the medical expenses incurred by Reji for his treatment, Rs 30,000 as compensation for unfair trade practices, mental agony, and hardship suffered by the complainant and his family.
“I am an ordinary citizen, and I took the insurance coverage of Rs 23,000 expecting it to support me in case of any emergency medical situation. The insurance promised a sum assured of Rs five lakh for cashless bill payments at hospitals. But when I was in need of the support, they denied it. I reached out to the insurance company through their customer care number, but they cold-shouldered my requests, totally refusing to entertain my claim. I decided to fight the case legally against the company after I realised that I was duped with promises of support during medical emergencies. Our country has laws protecting our rights. We should legally fight injustices of this sort. I am happy that I could win a favourable verdict despite the insurance company strongly fighting to oppose my petition,” Reji told “Open Digest“.
Advocate Sonymon K Mathew, who appeared for Reji, said people should come forward to fight against the insurance companies which continue to deny claims citing flimsy reasons. “The insurance companies counter the claims submitting that the consumer has taken the insurance fully accepting the terms and conditions stipulated by them. They keep on finding reasons to deny the claims. But our consumer protection laws are strong, and our Supreme Court has upheld the rights of the consumers,” he said.
In the judgment, Commission president D B Binu, Members V Ramachandran and Srividhia T N observed that “the complainant has endured considerable inconvenience, mental distress, hardships, and financial losses as a result of the negligence of the opposite party. In view of the above facts and circumstances of the case, we are of the opinion that the opposite parties are liable to compensate the complainant.”
The victory was a moment of profound relief and triumph for Reji. “This case was never just about me. It was about standing up for everyone who has been bullied by these big companies. I hope this inspires others to fight for their rights and not be intimidated,” Reji added.
