Insurer asked to pay Rs 15,000 compensation for rejecting health insurance claim
The consumer disputes redressal forum, Chandigarh, has directed an insurance company to pay Rs 15,000 as compensation for deficient services to the nominees of the insurer for rejecting the claim by invoking an exclusion clause.chandigarh Updated: Mar 10, 2014 23:21 IST
The consumer disputes redressal forum, Chandigarh, has directed an insurance company to pay Rs 15,000 as compensation for deficient services to the nominees of the insurer for rejecting the claim by invoking an exclusion clause.
Ruhi Sharma, a resident of Sector 40, had moved the consumer forum against the Oriental Insurance Company Limited, alleging that her father namely Par Brahm Sharma had bought a policy in February 2011 for a sum insured of Rs 2 lakh.
She said that her father died in December 2011 and doctors said he died due to pneumonias refractory cardiogenic shock. However, her claim was rejected, citing an exclusion clause. She had then approached the forum. Disposing of the complaint, the forum also directed Oriental Insurance Company Limited to reimburse the claim to the tune of Rs 2 lakh along with 9% interest with Rs 7,500 as cost of litigation. Though the complaint was filed by Ruhi only, but the amount would be shared between three legal heirs of insurer which include Ruhi, her sister Shivranjani, and brother Sidhant Sharma.
Oriental Insurance company Limited, said that the victim had deliberately concealed the fact relating to pre-existing diseases from the insurance company in order to avail a false claim. They said the PB Sharma was suffering from hypertension and diabetic Mellitus for two years and both these are confirmed risk factors of coronary artery disease and were not covered under the policy.
The consumer forum presided over by PL Ahuja on March 6, said, "In the absence of any definite evidence of pre-existing disease, at the time of filling up of the proposal form for the insurance policy by the deceased, we feel that the claim could not be repudiated by the insurance company on grounds of exclusion policy."
The forum said, "We are of the view that insurance company could not repudiate the claim on the ground that the said disease was contracted or manifested during the currency of the policy, therefore, the expenses are not payable. So, the repudiation of the claim amounts to deficiency in service and unfair trade practice."