Bajaj Allianz General Insurance ordered to pay for treatment in UK

Ahmedabad: The consumer court has ordered an insurance company to pay medical expenses to a person for treatment he availed for a stroke in UK, after the company refused to pay on the grounds that the consumer had suppressed information that he was a diabetic.

The Gujarat State Consumer Dispute Redressal Commission said that the insurance company – Bajaj Allianz General Insurance – was not able to establish that the brain stroke that its customer from Surat, Hasmukhlal Parekh, suffered during his UK trip was actually caused by diabetes.

Hence, Parekh not revealing that he was diabetic while obtaining the mediclaim policy was not a condition on the basis of which medical expenses could be denied to him. The commission upheld the Surat District Consumer Dispute Redressal Forum’s order to the insurer to pay Rs 3.5 lakh to Parekh.

In this case, Parekh had to go to UK trip in March 2009 for three months and he obtained a mediclaim policy for four months covering $50,000 and paid Rs 2,227 towards the premium.

On April 24, 2009, Parekh suffered a stroke after morning walk. He was admitted to the Central Manchester University Hospital, which treated him after the insurance company granted approval of cashless payment.

In July 2009 after Parekh’s return to India, the hospital sent him a bill of £ 4,285 saying that he was liable to pay it. Parekh came to know that the insurer refused to pay the bill on the grounds that he had not disclosed that he was a diabetic for the last 15 years while obtaining the policy.

When the dispute was heard in the consumer courts, Parekh’s advocates argued that he had not disclosed his disease, but the insurance company did not establish any connection of the present ailment with diabetes.

The consumer courts also accepted that the insurance company could not establish that Parekh’s stroke was caused due to his diabetic condition.

And since there was no direct nexus established between stroke and diabetes, the insurer was liable to bear treatment expenditure.

Source: The Times of India