DCDRForum : Insurance Company must pay compensation for rejecting claim

       Insurance companies have been known to reject claims on trivial grounds. Some times based on concocted reasons. Here is a case where the DCDRF has rendered justice to the claimant for the wrong rejection of his claim.

Insurance co to pay 7L for trashing patient claim

 Rebecca Samervel TNN

     Mumbai: The Mumbai Suburban District Consumer Disputes Redressal Forum recently ordered The National Insurance Company Ltd to pay Rs 1.5 lakh compensation for wrongly repudiating the insurance claim of a Khar resident who underwent heart surgery in 2009. The complainant, Praveen Nischol, will also get the Rs 5.11 lakh he spent on the surgery. The company had rejected the claim on the ground that he was suffering from hypertension and diabetes before he took the mediclaim, but the discharge card proved it wrong.

     Nischol had taken the mediclaim policy in 2007 and it was valid till October 2008. Since he was suffering from various aliments, on February 25, 2009, he was admitted to a hospital. After undergoing a surgery, he was discharged on March, 7, 2009. However, when he sent his claim form to the insurance company, it rejected it on the grounds of preexisting disease. After failing to get any relief from the Insurance Ombudsman, Nischol filed the complaint before the forum on April 12, 2010.

     He also submitted various documents and his medical papers from the hospital. Among the documentary evidence, he presented his discharge card from the hospital where he underwent the surgery. The document stated that Nischol was suffering from diabetes and hypertension since January 2009.

     The forum held that since the insurance company had not submitted any documents to prove their version, the facts mentioned in the discharge card would be accepted. It further stated that the discharge card proved that Nischol was
not suffering from any of the ailments when the insurance policy was procured in 2007.

     Holding the company guilty of deficiency in service, the forum also stated that Nischol had undergone surgery for the heart ailment and not for the other diseases.

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