Sahara Care to pay Rs 2.5L to legal heirs of policy holder

NEW DELHI: Sahara Care, an insurance firm of Sahara group, has been directed by a consumer forum to pay Rs 2.5 lakh reimbursement and compnesation to the legal heirs of one of its mediclaim policy holders, who died during treatment with the firm refusing to settle medical expenses over it.

The District Consumer Disputes Redressal Forum passed the order, holding the company guilty of being "deficient" in providing medical facility, under its policy.

"Holding respondent deficient in providing the medical facility and reimbursement of the claim under the policy, we direct it to pay a sum of Rs 2,00,000 under the policy of medi claim to the heirs of the deceased Jagat Singh together with Rs 50,000 as compensation for causing harassment to his heirs," the forum said.

Narender Singh, son of late Jagat Singh, in his plea had said his father had purchased the cashless mediclaim policy, which provided a cover of Rs 2 lakh, from Sahara Care in January 2010.

He said his father was hospitalised in the Fortis Hospital at Noida in February 2011 and subsequent to his death all relevant documents were given to the company, despite which, it had not settled the claim.

Sahara Care had contended the claim was rejected as the company was not informed about the hospitalisation, within 24 hours of the same.

The forum presided over by N A Zaidi brushed aside the contention, saying Jagat Singh was hospitalised in serious condition and in that situation "if there was any delay at all the same can safely be ignored".

"It is not expected when the patient is in a critical stage that anybody will think of first informing the insurance company and then asking for the treatment.

The life is the first priority for the doctor as well as for the attendants," it said, adding "insurance company cannot be allowed to take the benefit of the adverse circumstances of the insured and they cannot escape from their liability."