Pay Rs 20L medical claim to complainant, firm directed

Avneet Kaur

Jalandhar, February 17

The District Consumer Disputes Redressal Forum has directed a private insurance company to pay Rs20 lakh as medical expenses to a city-based resident for repudiating his overseas medical claim.

Ajinder Kaur, a resident of Jalandhar Vihar, had filed a complaint against Religare Health Insurance Company Limited, alleging that she was lured into purchasing an overseas mediclaim insurance policy under a plan, ‘Explore Canada +’ for a travel period of 179 days as a proposer on the life of Harwant Singh, father-in-law, and Parvinder Kaur, mother-in-law. According to the complainant, the policy covered risk insured against hospital cash and major surgical benefits.

In her complaint, Ajinder said she had purchased the policy in March 2018, for a period of six months from April 4, 2018, to October 7, 2018, for a insured amount of USD 100,000 for each — for her mother-in-law and father-in-law — and paid its premium amount on time.

She said after purchasing the insurance policy, her father-in-law Harwant Singh went to Canada and unfortunately on May 3, 2018, he fell ill and was admitted to Survey Memorial Hospital. He got proper treatment and was discharged on May 11, 2018. She said they paid Rs Rs 20 lakh for treatment and medicine purchased by them.

According to her, when they approached the insurance company and informed it about the expenses on treatment of Harwant Singh and made claims for the reimbursement of the money, the company rejected the claims. She added that the insurance company said the insured person was suffering with hypertension and hyperlipidemia for long and the same was not disclosed by the family when they had purchased the policy.

However, she said according to medical certificates, Harwant Singh was in the pink of his health at the time of purchasing the policy. She said insurability with no physical impairment and pre-existing disease/ illness were mentioned in the proposal form. He was not afflicted with hypertension and hyperlipidemia.

A notice of the complaint was sent to the opposite party. In its reply to the forum, it said, “There was non-disclosure of material information by the complainant at the time of taking the insurance policy. The expenses in the present case are attributable to, arising out of, traceable to and a complication of pre-existing ailment of the complainant and not payable under the policy terms and conditions.”

After going through the facts presented by both parties, Karnail Singh, president of the forum, and member Jyotsna in its judgment held the company liable for rejecting the claim on baseless grounds and directed it to reimburse the medical treatment expenses of Rs20 lakh.

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