Company has to pay standard coverage of Rs. 15,000
Deadline of March 15 fixed for payment of the amount
MANGALORE: The Dakshina Kannada District Consumer Disputes' Redressal Forum has asked an insurance company to pay Rs. 15,000 to Chandappa Padil, a daily wage earner from Padil, in addition to a compensation of Rs. 8,000 and litigation cost of Rs. 1,000.
Reliance General Insurance Ltd., Hampankatta, had issued a group insurance policy certificate with standard coverage of Rs. 15,000, valid up to July 2009, to Mr. Padil.
He was treated for pain and swelling on the left knee in June/July, 2009 at KMC Hospital, where he underwent an excisional biopsy. Although Mr. Padil had sought an extension of cashless treatment benefit under the policy, the company declined it.
Mr. Padil contended that denial of cashless treatment benefit amounted to deficiency of service. When he issued a legal notice to the company, it had sent an undated letter to him saying that he had had the problem for two years, and since it was treated as a disease that existed prior to the inception of the policy, the company was not liable to pay.
The forum said the burden of proving a pre-existing disease lay with the company. It pointed out that Mr. Padil had admitted that he was a diabetic since two years but there was no record or evidence to show that he had undergone treatment for the knee problem before obtaining the policy.
The forum, headed by Asha K. Shetty, said the company had not given evidence or produced documents to show that Mr. Padil had a pre-existing disease.
Although Mr. Padil had spent Rs. 43,734, he was entitled to get Rs. 15,000 under the policy with standard mediclaim coverage, compensation of Rs. 8,000 for harassment and mental agony, and Rs. 1,000 as cost of litigation, by March 15, the forum ordered.