1 April 2010
New Delhi, India
The Delhi State Consumer Commission has directed an insurance company to pay medical expenses incurred by a patient within a year of taking a mediclaim policy even though the exclusion clause stated otherwise.
The Commission noted that the insurance company was guilty of not bringing the exclusion clause to the notice of the policy holder while issuing the policy.
The exclusion clause stated that no medical reimbursement would be provided to a policyholder if he suffers from a disease within a year of taking it.
“There is no mention of internal congenital disease like ASD disorder from which the complainant suffered and for which he was operated upon. We find no infirmity in the impugned order (of the District Forum) because exclusion clause was not brought to the notice of the complainant and, hence it cannot bind him,” the Commission said.
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