Ombudsman tells insurance company to settle claim

Legal Correspondent

Advertisement

Ludhiana, October 28

Showing dissatisfaction over the denial of a mediclaim, the Insurance Ombudsman has ordered an insurance company to settle the claim of aggrieved woman Usha Gupta of Bhai Randhir Singh Nagar, Ludhiana, within 30 days.

The complainant has submitted before the Ombudsman that she has been paying the mediclaim premium from the past 25 years. As she was feeling dizzy, she got admitted to the DMC Hospital on September 3, 2017.

After discharge from the hospital, she submitted her claim with the United India Insurance Company, but the company denied the claim. She was admitted in the emergency in critical condition whereas the insurance company justified the denial of claim.

It was pleaded that the complainant was diagnosed with vertigo, which is often caused by an inner ear problem.

Some of the most common causes includeed BPPV which can occur for no known reason and may be associated with age. This kind of psychiatric problem was not covered in the policy.

Even as per policy, no hospitalisation was required for this problem. So the claim was not payable, they claimed.

But after appreciating the evidence on record, the Ombudsman observed that how can the insurance company conclude that vertigo is caused by psychiatric problem when there are numerous reasons of vertigo. So, the insurance company should settle the claim.

But after hearing both the parties and appreciating the evidence on record, the Insurance Ombudsman disagreed with the decision of the insurance company and ordered the company to settle the claim.