Virudhunagar District Consumer Redressal Forum on Monday ordered the Oriental Insurance Company in Rajapalayam to settle the medical bill to a mediclaim insurance policy holder along with a fine of Rs. 10,000 and Rs. 3,000 for the legal expenses.
Hearing the case of V.K. Beemaraja, who claimed that the nationalised insurance company refused to pay him Rs. 16,669.20 towards a cataract surgery despite that his mediclaim policy was renewed for the second time.
The insurance company rejected the claim, contending that the policy holder had failed to renew the policy for the second time on time. He had renewed the policy only after a lapse of three days and hence it could not be considered as a continuous renewal policy but only a fresh policy.
"As per the policy conditions, cataract surgery are not payable for the first two years. If the policy is renewed continuously without a break it is payable for 3rd year," it claimed.
However, when the case came up for hearing, the forum chairman, V. Balasundarakumar, quoting a Supreme Court verdict on a similar case, said that the policy in vogue could be considered only as the continuously renewed policy and could not be taken as a fresh policy as the policy holder has not given any separate proposal form meant for a fresh policy as claimed by the insurance company.
The medical claim should be paid within one month or else pay it with an interest at the rate of 6 per cent till the date of payment.
Besides, the forum also ordered to pay a compensation of Rs. 10,000 for the mental agony and Rs. 3,000 towards legal expenses.
