By Chitra Unnithan,
Consumer Education Research Society (CERS) recently won a case at the State Commission in favour of an insurer whose claim was not fully settled by New India Assurance Company.
As per the case details, Asha Rungta was insured under a health policy for the period effective from 1st March, 2006 along with other family members. Rungta's sum assured was Rs 4 lakh. In 2007, Rungta was hospitalized for a month for the treatment of 'interstitial lungs disease'. For the said expense, a claim for Rs. 3,75,395 was placed but the insurance company sanctioned only Rs 2,00,000 on the grounds that Rungta was suffering from this disease since the year 2003 and at that time the sum assured was Rs 2,00,000 only, thereby, stating that she was not entitled for the remaining claim amount.
After repeated pleas to settle the claim went unheard, CERS filed the complaint on behalf of Rungta before the consumer forum. As the insurance company did not produce any documents to support their deduction and the policy was first issued to complainants in the year 2000, the forum passed the verdict in favour of the complainant and ordered the insurance company to pay Rungta a sum of 1,75,395 and Rs 1,250 towards cost of litigation.
Following the verdict, the insurance company approached the State Commission. After hearing arguments from both sides, the State Commission also observed that the insurance company had not produced proof of pre-existing disease or affidavit of doctor to support their claim of pre-existing disease and upheld the order passed by the forum with regard to insurance company.
"This case again brings to light how insurance companies deny rightful insurance claims by giving unsubstantial reasons for rejection," officials at CERS said.
Source The Times of India
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