Insurance firm told to pay Rs 1.55-lakh claim, relief

Insurance firm told to pay Rs 1.55-lakh claim, relief

Tribune News Service

Jalandhar, February 25

The District Consumer Disputes Redressal Forum has directed HDFC ERGO General Insurance Company Limited to pay Rs 1.55-lakh claim to a Nakodar-based complainant along with 12 per cent interest for three years and Rs 10,000 compensation for causing the delay.

The complainant, Charanjit, a resident of Boparai Kalan village, said his son Ravi Pal, who worked with the Punjab Police (last posting at the Mehatpur police station here), died in April 2017 due to brain tumour.

Through his lawyer Harbhajan Sampla, the complainant said his son had purchased an insurance policy, ‘Sarv Suraksha’, from the company for a period starting from October 20, 2014, to October 19, 2017, covering critical illness. A one-time premium of Rs 2,453 too was paid from the salary account of Ravi Pal.

Ravi died during his treatment at the PGI, Chandigarh.

His father said he informed the insurance company about the death. Being his nominee, he lodged a claim on May 21, 2017, against the policy but the claim was rejected on the ground: “The said ailments are not covered under the policy,” whereas critical illness was not explained to the insured/deceased, Ravi, at the time of purchase of the policy. As per reports, Ravi died due to raised intracranial pressure, chronic meningoencephalitis and tuberculoma.

The forum went through the copy of terms and conditions in the insurance policy. It listed out ‘Cancer of specified severity’ on its fourth page under the heading of critical illness coverage.

The forum said the policy itself cited that the ailment of the deceased was covered because as per the certificate issued by the treating doctor, the MRI showed left frontal lobe brain tumour and the victim was operated twice.

Thus, the forum directed the insurance firm to pay Rs 1.55 lakh to the complainant with 12 per cent rate of interest per annum from the date of death of the deceased till realisation. It also directed the company to pay compensation for causing mental tension and harassment to the complainant to the tune of Rs 7,000, besides Rs 3,000 as litigation expenses.

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