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Chandigarh: Cancer patient dies waiting claim, forum slaps fine of on insurance firm
Varinder Jindal alleged that his wife Czarina Jindal had bought a health insurance policy in 2015 from the Niva Bupa Health Insurance Co. Ltd. from January 9, 2015, to January 8, 2016, and it was renewed every year
The District Consumer Dispute Redressal Commission, Chandigarh, has imposed a penalty of over ₹11 lakh on Niva Bupa Health Insurance Co. Ltd. for rejecting a brain cancer patient’s claim, who died awaiting the claim amount. It also asked the firm to pay ₹30,000 compensation for causing mental agony and harassment to the patient and her family, and ₹10,000 as the cost of litigation.
Varinder Jindal, from Dhakoli, Zirakpur, filed a case against Niva Bupa Health Insurance Co. Ltd. (formerly known as Max Bupa Health Insurance Co. Ltd.), Chandigarh, and its office in Gurugram. Alchemist Hospital, Panchkula, was also made a party.
Jindal alleged that his wife Czarina Jindal had bought a health insurance policy in 2015 from the Niva Bupa Health Insurance Co. Ltd. from January 9, 2015, to January 8, 2016, and it was renewed every year.
“During June 2021, Czarina suffered from meningioma (brain tumour) for which she got treatment from Alchemist Hospital and Fortis Hospital, Mohali. Meanwhile, Alchemist hospital got three security cheques from the complainant and her daughter Vrinda Jindal till the settlement of insurance claims,” the complainant added.
It was added that the insurance company repudiated the claim dated October 7, 2022, and October 22, 2022, towards bills totaling ₹11,09,547 on the grounds of non-disclosure of disease.
It was further stated Czarina filed a consumer complaint and it was allowed via order dated January 3, 2017. However, the amount was not cleared and Czarina died on October 20, 2022.
The complainant mentioned that the insurance company is negligent and deficient in their service and liable for unfair trade practices.
In the forum, the insurance company contested that upon scrutiny of the claim and investigation done, the claim was denied due to non-disclosure of a history of gamma knife surgery done in 2005, the claim request was denied in accordance with policy.
It is further stated that gamma knife radiosurgery is a type of radiation therapy used to treat tumours, vascular malformations and other abnormalities in the brain.
Seeking dismissal of the complaint, it was argued that this fact was not disclosed by the insured/policyholder at the time of taking the policy.
Nobody appeared from the side of Alchemist Hospital, hence the case proceeded ex-parte.
The forum, from the available documents, observed that the policies were renewed in respect of the deceased insured continuously and the opposition parties were aware of the pre-existing disease.
The forum directed the insurance company to pay the claim dated June 2022 amounting to ₹9,06,714 and the claim dated October 2022 for ₹2,02,833 to the complainants, along with interest @ 9% per annum, with effect from the dates of repudiation till realisation, so as to enable the complainants to pay the amount to the hospital.