Pay Rs 4.58L medical claim to complainant, firm directed

Tribune News Service

Amritsar, February 16

The District Consumer Disputes Redressal Forum has directed an insurance company to pay a medical insurance claim of over Rs4.58 lakh with nine per cent interest, besides Rs10,000 as litigation expenses to a city resident. The firm has to pay the interest from the date the complaint was filed.

Earlier, Rohit Sabharwal of Anand Avenue had filed a complaint against United India Insurance Company stating that he had purchased a medical insurance policy in 2002 and renewed it every year. He said he remained hospitalised and spent an amount of Rs4,58,600 on his treatment. He said, “The firm repudiated my claim on grounds that atrial septal defect is a heart defect, which was presented at the time of birth. Hence, all congenital diseases fall under the permanent exclusion of the policy.”

The firm in its reply stated that the atrial septal defect was a heart defect, which was present at the time of birth and thus, it was congenital in nature and the policy excluded such disease.

The forum said the opposite party had not brought any record to show that any genetic tests were done to prove its claims and therefore, the finding of being a congenital disease was arrived at. It added that the onus was on the opposite party to prove that the complainant had taken treatment for the said disease earlier too. It added that under this situation, genetic tests were mandatory to arrive at a conclusion that it was a congenital disease.