Insurance firm fined for refusing mediclaim

Kapurthala, December 8

The Permanent Lok Adalat, Kapurthala, led by chairman Mukesh Bansal and members Dr Manjit Kaur and Dr Upasana Verma, has directed Religare Health Insurance to pay Rs 3 lakh claim money to the applicant, Kavita Aggarwal, within next two months. The court also mandated an interest rate of 9 per cent per annum from July 2, 2017, until the actual realisation of the payment.

The case revolves around the demise of Kavita Aggarwal’s husband, Sunil Aggarwal, who held a medical insurance policy with Religare. He fell ill and sought treatment at Patel Hospital in Jalandhar. He was admitted there from June 14 to June 21, 2017, and subsequently from July 2, 2017, until his death on July 3.

Upon approaching Religare officials for assistance with the medical expenses, Kavita Aggarwal faced refusal, citing her husband’s condition as critical illness. Despite her efforts for an amicable settlement, the insurance company later denied the claim, alleging Sunil Aggarwal’s alcoholism and chronic smoking as reasons.

In response, Kavita, represented by advocate Anuj Anand, filed a case in the Permanent Lok Adalat. The respondents contested the case, asserting that Sunil was a chronic smoker, a claim they failed to substantiate.

Following a thorough examination of documentary evidence and arguments from both parties, the Lok Adalat Bench concluded that the applicant was rightfully entitled to the claim. Consequently, the court ordered Religare Health Insurance to disburse Rs 3 lakh to Kavita Aggarwal within two months, in addition to Rs 50,000 for causing mental agony and harassment and Rs 11,000 as litigation expenses.

The court emphasised that failure by the respondents to make the payment within the stipulated two months would result in the applicant being obligated to pay the entire amount, including litigation expenses, with an increased interest rate of 12 per cent, enforceable through legal execution.