Ludhiana | Insurance company directed to reimburse 2 lakh medical claim

Mohit Sharma of Ludhiana had submitted a complaint against the branch manager of opposite party (OP), Reliance General Insurance Company Ltd, Ludhiana, alleging deficiency in service for its failure to reimburse a medical claim of 2 lakh
“The claim was not payable as the Ludhiana complainant was a known case of diabetes mellitus since 2011 and he was taking regular treatment for the said disease but this fact was not disclosed by the complainant in the proposal form at the time of policy inception”, averred the counsel for the insurance company. (HT FILE)
“The claim was not payable as the Ludhiana complainant was a known case of diabetes mellitus since 2011 and he was taking regular treatment for the said disease but this fact was not disclosed by the complainant in the proposal form at the time of policy inception”, averred the counsel for the insurance company. (HT FILE)
Published on May 08, 2022 11:04 PM IST
Copy Link
By, Ludhiana

For its failure to reimburse a medical claim of 2 lakh to a patient, District Consumer Disputes Redressal Commission on Sunday directed Reliance General Insurance Company Ltd to release the claim and pay 7,000 compensation to the complainant.

Mohit Sharma of Ludhiana had submitted a complaint against the branch manager of opposite party (OP), Reliance General Insurance Company Ltd, Ludhiana, alleging deficiency in service.

Sharma bought a medical policy from the OP in August 2015, which was renewed from time to time. The wife and minor son of the complainant were also covered under the said policy.

On December 12, 2019, the complainant was admitted to SPS Hospital, Ludhiana, due to a major heart attack.

The complainant remained admitted till December 14, 2019.

Since there was no cashless facility, the complainant spent an amount of about 2, 00,000 on his treatment.

After getting discharged from the hospital, the complainant applied for the reimbursement of the claim and submitted all the necessary documents with the said insurance company. Mohit said his claim was rejected by the OP and the policy was also cancelled on the ground that the former had not disclosed in the proposal form that he was suffering from diabetes.

The complainant asked the OP to provide him the proposal form and other documents, but the insurance company refused to do so, alleged Mohit.

Hence, the complainant sought reimbursement of the total bill of 2.02 lakh along with the compensation of 5 lakh.

However, refuting the allegations, the insurance company pleaded that the complaint was false and frivolous.

“The claim was not payable as the complainant was a known case of diabetes mellitus since 2011 and he was taking regular treatment for the said disease but this fact was not disclosed by the complainant in the proposal form at the time of policy inception”, averred the counsel for the insurance company.

Meanwhile, the Commission in its order observed, “It is a settled proposition of law that diabetes mellitus and hypertension are common diseases and it is not necessary that every person suffering from hypertension and diabetes mellitus would also suffer heart attack. Even otherwise, in this case the factum of non-disclosure of pre-existing disease of diabetes mellitus has not been established by the opposite party. Under these circumstances and considering the fact that the proposal form has not been placed on record by the OP, it has to be held that the repudiation of the claim by the OP is not justifiable and the same is liable to be set aside”.

Commission further directed the OP to consider and reimburse the claim in respect of hospitalisation of the complainant from December 12, 2019 to December 14, 2019, strictly, as per terms and conditions of the policy, and also to pay a composite of 7,000 to the complainant.

SHARE THIS ARTICLE ON
Close Story
QUICKREADS

Less time to read?

Try Quickreads

  • Punjab chief minister Bhagwant Mann speaks during the Budget session, in Chandigarh on Saturday. (PTI)

    Punjab CM Bhagwant Mann announces educational, health reforms for state

    Listing out the achievements of the Aam Aadmi Party government during the first 100 days in office, chief minister Punjab Bhagwant Mann on Saturday announced multipronged improvements in the education sector, which he termed the bedrock for building a new society. Winding up the discussion on governor's address, he also termed the Emergency a “big blot” on India's democracy, lambasting it as a period when people's voice was suppressed.

  • HT Image

    PROA passes resolution against financial commissioner revenue for mistreatment of officers

    Punjab revenue officers' association has passed a resolution against financial commissioner revenue Anurag Aggarwal, condemning his alleged arrogant and humiliating attitude towards revenue officers. President of PROA, Gurdev Singh Dham, said that a meeting of executive body of the association was held to discuss various issues, including revengeful attitude and misbehaviour of FCR Anurag Aggarwal towards revenue officers.

  • Ruins of Maharaja Ranjit Singh’s mansion to host religious event on his death anniversary

    Ruins of Maharaja Ranjit Singh’s mansion to host religious event on his death anniversary

    In an effort to regain the lost splendour of Maharaja Ranjit Singh's historical buildings at his summer capital Dinanagar in Gurdaspur and promote tourism, the district administration, for the first time, will organise a religious event in the ruins of the Sikh ruler's mansion on June 29 to mark his death anniversary. During the religious function, path of Sukhmani Sahib will be held in a pandal.

  • HC allows Jalandhar man to go abroad; says pendency of an FIR no ground to deny him permission

    HC allows Jalandhar man to go abroad; says pendency of an FIR no ground to deny him permission

    The Punjab and Haryana high court has allowed a Jalandhar man, an accused in a criminal case, to go abroad, observing that pendency of an FIR would not mean that The petitioner, Kanwalpreet Singh Kalra would not return back. The petitioner, Kanwalpreet Singh Kalra, had approached the high court after he was denied permission to fly to Canada to attend the convocation ceremony of his daughter by a Jalandhar court.

  • Finance minister Harpal Singh Cheema presented AAP government’s white paper two days before his first budget presentation. (HT Photo)

    Congress regime spent recklessly, left behind 24,351 crore unpaid liability: Mann govt’s white paper

    Two days ahead of its first budget, the Aam Aadmi Party government in Punjab, while painting a grim picture of the state finances, on Saturday tore into the previous Congress government for “reckless spending” and saddling it with “unpaid liability” of 24,351 crore besides a colossal debt. Another 7,117.86 crore is unpaid power subsidy claimed by Punjab State Power Corporation Limited for supply to agriculture, domestic and industry consumers last year.

SHARE
Story Saved
×
Saved Articles
Following
My Reads
Sign out
New Delhi 0C
Sunday, June 26, 2022