A Panchkula family running from pillar to post to get an insurance claim for the past two years finally got relief as the state consumer disputes redressal commission directed the insurance company to pay the claim of ` 1 lakh, along with ` 15,000 as compensation, for deficient services and unfair trade practices.
Dismissing an appeal filed by the National Insurance Company Limited, the consumer commission upheld the order of consumer forum and directed the insurance company to pay ` 1 lakh to the widow and children of Jammaluddin Mondal, a resident of Panchkula, with 9% interest from the date of filing of the claim till its realisation, along with ` 7,500 as cost of litigation.
Mondal’s widow Laila Mondal had moved the consumer forum after the insurance company had rejected her claim.
As per the complaint, Jammaluddin had purchased the mediclaim policy for himself, his spouse and children for an amount of Rs 1 lakh.
He died in December 2012 due to a cardiac arrest, following which Laila filed a mediclaim that was repudiated by the insurance company in March 2013 claiming that the patient was a known case of hypertension and on the date of commencement of the policy, the disease was pre-existing.
Upholding the order of consumer forum, the consumer commission stated, “Insurance company failed to prove that the deceased was suffering from any disease like hypertension and coronary artery disease at the time of purchase of the mediclaim policy in 2012 or if he was aware of suffering from such disease. The contention of insurance company, thus, being devoid of merit, is not sustainable and stands rejected.”
“The district consumer forum, thus, rightly held that the mere fact that the deceased affixed his signature on a printed declaration that he had read the salient features of the policy did not warrant that terms and conditions were read by him or was made known to him,” ruled consumer commission, while reiterating “Non-payment of the claim of ` 1 lakh to the widow and children amounted to deficiency in rendering service and indulgence in unfair trade practice on the part of the insurance company.”