Madurai District Consumer Disputes Redressal Forum has asked an insurance company to pay Rs. 1 lakh to a health insurance policy holder for expenses incurred by him for medical treatment, and pay a compensation of Rs. 7,000 for deficient service.
According to V.Sudalaimuthu of Kochadai, he paid Rs. 4,899 as premium to Oriental Insurance Company towards a health insurance policy taken in 2001. In 2006, Mr. Sudalaimuthu underwent treatment at Apollo Specialty Hospital in Madurai for heart ailment and an open heart surgery that cost Rs. 1.50 lakh was performed on him. Despite the litigant's repeated claims and reminders, the insurance company failed to pay.
And it rejected the medical claim on July 20, 2007, stating it was not liable to pay the cost because Mr. Sudalaimuthu had diabetes for seven years before taking the insurance policy. The heart ailment was a result of diabetes and hence the company did not have to pay the medical claim.
Dismissing the claims of the insurance company, forum president P. Deivaraj and member N. Thilagam held that the petitioner was entitled to the benefits of the insurance policy and directed the insurance company to pay Rs. 1 lakh for the treatment, and Rs. 7,000 for its deficient service within a month.