Rebecca Samervel
A consumer forum has held that if an insurance firm rejects a claim on the grounds of pre-existing disease, the onus is on them to prove the pre- existence with the help of cogent and expert evidence. The forum told Royal Sundaram Alliance Insurance Co Ltd to pay the husband of a cancer survivor, a Thane resident, an insurance amount of Rs 1.50 lakh along with a compensation of nearly Rs 1.45 lakh.
Holding the insurance firm guilty of deficiency in service, the district forum said, "The company repudiated the claim on the grounds that the woman was suffering from breast cancer prior to the commencement of the policy, then the onus lies on the opponent to prove this, that too by cognate evidence. But without any document or opinion on record, the opponent has rejected the complainant's claim."
The complaint was filed before the Additional Mumbai Suburban District Consumer Disputes Forum in October 2007. The complainant had taken the mediclaim policy for his family members and himself in October 2005. He said on March 20, 2006, his wife noticed a lump in her left breast. After undergoing a biopsy, the cancer was diagnosed. Over the next few months, she underwent treatment at a city hospital, following which the husband filed a claim. However, the company repudiated it.
A letter by the firm to the complainant, rejecting the claim, had a certificate by the doctor who had diagnosed the cancer. Referring to it, the forum said, " Perusal of the certificate, it is clear there was no evidence to prove that the lump the wife of the complainant had, existed before October 2005."
Source The Times of India
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