Insurance firm told to pay relief

Tribune News Service

Amritsar, June 18

The District Consumer Disputes Redressal Forum has directed an insurance company to pay Rs 1,72,475 to a local resident whose medical claim was earlier repudiated. The company has also been directed to pay Rs 2,000 as litigation expenses.

Earlier, a local resident, Paramjit Singh, had filed a complaint against HDFC Ergo General Insurance company, stating that he obtained a medical insurance for the period starting from February 25, 2016, to February 24, 2017, by paying a premium of Rs 15,058 for the assured sum of Rs 3 lakh.

He said he was taking the policy for the past four years but due to the negligence of the agent of the opposite party, the break occurred in continuation of the policy as a result of which he was issued a new policy.

The complainant alleged that during the validity of the period he fell ill and was admitted to a hospital for the treatment of cancer in right kidney and incurred an expenditure of Rs 1,83,225. He later filed a claim for Rs 1,72,475. He alleged that his claim was repudiated on a flimsy ground that the patient was a known case of hypertension before the first inception of policy, since two years. He denied that he ever remained a patient of hypertension.

The opposite party in its reply stated that as per medical record of the complainant, the insured is a known case of hypertension before the first inception of the policy. There is a history of hypertension since two years and the complainant had not disclosed the ailment while procuring the policy.

The reply stated that the complainant had not disclosed this fact to the opposite party before obtaining the policy, as such, the claim was repudiated.

The forum observed that no medical record showing such hypertension has ever been produced by the opposite party on the record. The forum also observed that the complainant had purchased the policy for four years and the last policy was issued with a gap as the insured was out of country.

It stated that the opposite party cannot wriggle out from their liability and is duty bound to continue the policy and reimburse the expenditure incurred on the treatment.

The forum further said these days, hypertension was not a material disease, therefore, non-disclosure thereof does not amount to concealment.