Insurance firm told to compensate over ₹60K

For ‘unjustified’ repudiation of mediclaim policy, notes consumer forum

June 02, 2019 01:36 am | Updated 01:37 am IST - New Delhi

A district consumer disputes redressal forum here has directed the United India Insurance Company to compensate a policy holder by paying over ₹60,000 for “unjustified” repudiation of a mediclaim policy.

The directions came when the consumer panel was hearing a complaint moved by city resident Paramjit Singh Belvi, who alleged that despite holding a valid mediclaim policy, the claim, meant for his wife’s treatment was rejected by the insurance firm on the grounds of a “pre-existing disease.”

Dismissing contentions put forth by the insurance firm, pertaining to clauses mentioned in the policy, the consumer panel observed, “We have read the contents of the policy with great circumspection. There is no mention in the policy as to the applicability of the relevant clause barring claim based on pre-existing disease.”

The consumer disputes redressal forum further observed, “Not only this, the terms and conditions of the policy were never supplied to the complainant. Since the insurance contract is in good faith, both parties have to be honest to each other. The insured should disclose the true state of his health and the insurer should apprise the insured of all the terms and conditions, which has not been done in the present case.”

Holding the insurance firm deficient in services, the bench additionally observed that the firm had failed to provide evidence of the “pre-existing disease.”

“Where the plea of pre-existing disease is taken up for repudiation of claim, the firm should lead medical evidence or examine the doctor who treated the insured. The firm has not led any such evidence,” the panel observed.

For harassment

Directing compensation of over ₹50,000, the consumer panel awarded an additional amount of ₹10,000 to the complainant for harassment and mental agony caused to the latter.

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