No claim denial for concealing disease
New Delhi: Delhi Consumer Commission has held that insurance companies cannot deny mediclaims on grounds of concealment of pre-existing disease unless the insured person undergoes operation or remains in hospital just before purchasing a policy.
‘‘Until a person is hospitalised or undergoes operation in near proximity of obtaining mediclaim policy or a year or two before that, he is not supposed to disclose day to day problems or normal wear and tear particularly in modern times, where a person lives a stressful life,’’ said the Commission.
Coming down heavily on insurance companies for repudiating claims, commission President Justice J D Kapoor said,‘‘They cannot take advantage of its act of omissions and commissions as they are under an obligation to ensure, before issuing mediclaim policy, whether the person is fit to be insured or not.’’
The Commission’s observations came while dismissing Oriental Insurance Company Ltd’s appeal against a district forum order, directing it to pay, as compensation, Rs 1.07 lakh, inclusive of an insured amount of Rs one lakh, to one Mohinder Singh. Singh purchased the policy on July 10, 2000 for one year and was hospitalised following chest pain. The angioplasty carried on him cost Rs 1.34 lakh.
‘‘It appears that insurance companies do not properly discharge their obligation, since half the population is suffering from such malaise and they would be left with either no or very little business,’’ it said. PTI
