Chandigarh: Future Generali India Insurance Company Limited told to pay Rs 30,000 for denying genuine claim

CHANDIGARH: The district consumer disputes redressal forum directed the Future Generali India Insurance Company Limited in Sector 17 to pay Rs 30,000 as compensation for rejecting the genuine medical claim of a senior citizen.

They were also directed to pay the claim amounting to Rs 11.85 lakh at an interest rate of 9% per annum since the date of repudiation. The complainant had gone to Australia when he fell sick and had to undergo treatment.

Harbans Singh Palla, a 72-year-old resident of Sector 51, stated in his complaint that he had availed the medical insurance policy ‘Future Travel Suraksha – Senior Citizen Insurance Policy’ for the period from May 9, 2016, to September 29, 2016, for the coverage of his visit abroad. During the coverage period, the complainant visited Sydney in Australia and there he was diagnosed with acute cholangitis (no predisposing factors) and on investigation, it was found that he had a 10mm stone. As a result, he had to undergo sphincterotomy and biliary stent was inserted. He was again admitted in a hospital in Australia on August 5, 2016, for the removal of biliary stent. He then applied for the medical claim but his request was rejected.

The insurance company stated in its reply that that the complainant concealed material facts about his previous disease/ailments and thus, he was guilty of suppression of facts which justified the repudiation of claim.

The forum, however, stated that the stand taken by the company is not convincing enough to justify the repudiation of the claim, since they failed to specify, by producing any particular document(s) whereby the complainant was asked to disclose about his previous ailments/disease and the answers given. Forum noted: “The copy of the two-page proposal form has been printed in such a miniature form with distorted print that it is quite hard to even read out the details given in the said proposal form including the so-called disclosures claimed to have been relied upon by the company which were further claimed to have been wrongly filled and signed by the complainant while availing the policy in question.”

The forum also noted that the complainant was issued the policy after having been made to undergo thorough medical examination “which divulges that the insurance company was having all the information and record regarding the health status of the complainant and only thereafter he was issued the policy in question”.

Stating that since the policy in question was issued by the insurance company in favour of the complainant only when it had satisfied itself regarding the health status of the proposer, the forum held: “Insurance company cannot be allowed to wriggle out of the liability to reimburse to the insured the medical expenses incurred during insurance period.”

Source: The Times of India