Insurance co told to pay Rs 53,000 for rejecting medical claim
An insurance company which refused to reimburse the medical bill of a policy holder has landed in trouble with a consumer court here directing it to pay Rs 53,000, including compensation, to him.
By PTI |
NEW DELHI: An insurance company which refused to reimburse the medical bill of a policy holder has landed in trouble with a consumer court here directing it to pay Rs 53,000, including compensation, to him.
The Royal Sundram Alliance Insurance Company Ltd had denied Manish Dhawan a medical insurance claim alleging that he did not disclose a pre-existing ailment at the time of taking the policy.
"The rejection of claim is based upon conjecture and is not sustainable," said District Consumer Forum, New Delhi, president K K Chopra, holding the company guilty of causing mental agony and harassment to the complainant.
"The insurance company did not feel the necessity of conducting various tests before issuing the policy. Then why did the company accept the premium and issue the policy?" it asked.
The Forum rejected the company's defence that it had the right to deny the reimbursement and directed it to pay Rs 33,627 against Dhawan's medical bills and pay Rs 20,000 for mental agony and litigation cost.
Dhawan, a resident of Kalkaji here, who underwent an operation for removal of gall bladder stones, was denied the claim following a report by the insurance company's doctors that his ailment existed prior to taking the policy and its non-disclosure rendered him ineligible for reimbursement.
"It does not take much time for stones to form and it is not necessary that the complainant must have been feeling the pain prior to taking of the policy," the Forum said.
Dhawan, on June 15 2004, had bought three medical insurance policies for himself, his wife and daughter for a period of one year.
The Royal Sundram Alliance Insurance Company Ltd had denied Manish Dhawan a medical insurance claim alleging that he did not disclose a pre-existing ailment at the time of taking the policy.
"The rejection of claim is based upon conjecture and is not sustainable," said District Consumer Forum, New Delhi, president K K Chopra, holding the company guilty of causing mental agony and harassment to the complainant.
"The insurance company did not feel the necessity of conducting various tests before issuing the policy. Then why did the company accept the premium and issue the policy?" it asked.
The Forum rejected the company's defence that it had the right to deny the reimbursement and directed it to pay Rs 33,627 against Dhawan's medical bills and pay Rs 20,000 for mental agony and litigation cost.
Dhawan, a resident of Kalkaji here, who underwent an operation for removal of gall bladder stones, was denied the claim following a report by the insurance company's doctors that his ailment existed prior to taking the policy and its non-disclosure rendered him ineligible for reimbursement.
"It does not take much time for stones to form and it is not necessary that the complainant must have been feeling the pain prior to taking of the policy," the Forum said.
Dhawan, on June 15 2004, had bought three medical insurance policies for himself, his wife and daughter for a period of one year.
Download
The Economic Times Business News App for the Latest News in Business, Sensex, Stock Market Updates & More.
The Economic Times Business News App for the Latest News in Business, Sensex, Stock Market Updates & More.
Download
The Economic Times News App for Quarterly Results, Latest News in ITR, Business, Share Market, Live Sensex News & More.
The Economic Times News App for Quarterly Results, Latest News in ITR, Business, Share Market, Live Sensex News & More.
ADVERTISEMENT
