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Tribune News Service
Amritsar, September 8
The district consumer disputes redressal forum has directed an insurance company to pay Rs 5,00,000 along with Rs 20,000 as compensation and Rs 5000 as litigation expenses to a local resident whose medical claim was earlier denied.
Earlier a resident, Vani Khanna had filed a complaint against Religare Health Insurance stating that her husband had purchased an insurance policy from the opposite party.
The insurance company had rejected the claim on the grounds that the patient had concealed the information about any pre-existing disease at the time of the purchase of the policy.
The complainant had also made the private hospital party to the complaint. The complainant alleged that the hospital did not get any relevant tests conducted to arrive at the conclusion.
The opposite party in its reply stated that it was found that complainant was a known case of SLE (Systematic Lupas Erythematosus). It stated that hospital documents revealed that the patient was suffering from the disease for the past 20 years. It stated that the claim was denied as per the rules.
The forum observed that insurers have failed to produce the treating doctor’s affidavit, discharge summary, treatment history and surgery schedule to prove their allegation of pre-existing disease.
It termed the repudiation of claim as arbitrary, unethical and for the sake of some collateral considerations. It stated that opposite party has based their above repudiation decision solely on presumptions and hearsay evidences and the same are not admissible in judicial adjudicatory. It stated that the record case-history with the hospital is nothing more than a ‘recital’ as narrated by the accompanying attendant and must be held in the light of some independent and cogent ‘proofs’ to impart it the legal authenticity and acceptability to settlement of the mediclaim.
Legal counsel for the complainant Gaurav Arora said that opposite party has been directed by the forum to pay the amount within 30 days.
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