The UT District Consumer Forum has penalised an insurance firm for wrongfully rejecting the mediclaim of a city resident. The insurance firm has been directed to reimburse the claim amount of Rs 30,000 along with the compensation amount and the litigation cost.
Ritu Gagneja, resident of Sector 46, was provided a mediclaim policy on opening an account with the Oriental Insurance Company. While she paid the premiums for the policy that would entitle her a refund of Rs 3 lakh for the treatment of any disease, Ritu claimed that the company rejected her mediclaim on insubstantial grounds. In the same year, Ritu was diagnosed with Cholelithion Billiary Colic C and was operated for the same at Dharam Hospital.
After she was discharged, Ritu approached the insurance company for reimbursement. However, the mediclaim was denied by the opposition party saying that the claim fell in the Exclusion Clause of two years as enshrined in the policy conditions. Also, the insurance company alleged that the treatment of the said disease came under the two-year exclusion clause, which is why the claim was non-payable.
However, the company failed to substantiate their allegations in the forum, where the complaint was accepted on the fact that the firm couldn't prove that the disease was included in the exclusion clause.
The forum has ordered the firm to compensate the complainant for causing mental agony within a month, failing which it would be held liable for paying the total amount with a 12 per cent interest.
Source: India Express
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