Forum tells insurance firm to pay Rs1.64 lakh to complainant

Tribune News Service

Amritsar, February 19

The District Consumer Disputes Redressal Forum has directed an insurance company to pay Rs 1,64,737 to a local resident within one month along with Rs 2,000 as litigation expenses.

Earlier, Sandeep Kumar Mannan had filed a complaint against National Insurance Company stating that he had purchased a medical insurance for his wife and their two children, which was valid from December 4, 2013, to December 3, 2014.

The complainant stated that during validity of the insurance his wife fell from a chair while working in her office as one of its leg broke. The complaint said due to sudden fall she developed pain in her spine, which could not be treated despite administering pain killers and taking bed rest.

Sandeep stated after consulting a number of doctors she was finally admitted to a hospital where she was treated for epidural. The complainant alleged that after treatment she developed post dural puncture headache, a side effect of epidural. He stated that the complication could not be resolved and she had to continue treatment at various hospitals. Sandeep said a total of Rs 1,64,737 was spent on treatment of his wife for which a claim was filed, which was rejected by the opposite party.

The insurance firm in its reply stated that the patient underwent epidural block on August 14, 2014, and later, hospitalisation was for management of post dural headache, which was because of complication of epidural injection.

It stated that Mediclaim Policy does not cover expenses incurred for surgery for prolapsed interventreal disc and related complications for the first two years of inception.

The complainant countered that such terms and conditions were neither given to them nor explained. The forum also observed that the opposite party could not produce any evidence to prove that such terms were explained to the insured before sale of the policy. The forum stated that insurance company had wrongly repudiated claim of the complainant.