A district consumer disputes redressal forum here has directed an insurance company to compensate a policyholder by paying over ₹2.68 lakh for repudiating a mediclaim policy on unjust grounds.
Holding Oriental Insurance Company deficient in services, the panel said: “The repudiation of the claim of the complainant by the insurance firm was unwarranted and unjustified.”
It also directed an additional compensation of ₹20,000 to be paid to the complainant. “It is now a well-settled law that insurance companies cannot escape under the umbrella of so-called terms and conditions to thwart legitimate and justified claim of the insured if the said terms and conditions were not supplied to the insured,” the panel said, adding: “In this case, there is no iota of evidence as regards to the supply of terms and conditions to the complainant.”
The directions came when the consumer forum was hearing a complaint moved by city resident Harinder Pal Singh who alleged that the firm had repudiated a mediclaim policy based on conditions that were not provided to him.
“The complainant made the entire payment of the medical treatment and filed a claim for reimbursement, which was rejected by the firm...It has been specifically mentioned that the firm did not supply the terms and conditions either to the complainant or his family members at any point of time,” read the complaint.
