04 October 2010
The Chennai District Consumer Disputes Redressal Forum (south) has asked United India Insurance to pay Rs 60,000 to a resident of T Nagar for wrongly rejecting his mediclaim policy. The insurance company had rejected the policy, stating that the client had a pre–existing condition. However, the forum observed that having accepted the proposal for the mediclaim policy, the company was liable to pay the claim. "The act of the company in rejecting the claim amounts to deficiency in service," the forum said.
On January 18, 2005, he had surgery as his constipation became acute. In February of the same year, he tried to claim Rs 50,000 for medical expenses. However, the insurance company rejected the claim, saying that it was a pre–existing condition and he had deliberately suppressed facts about his health. As per the discharge summary, symptoms of the disease were stated to be 2 years old. However, his general practitioner stated that the symptoms were just 3 months old.
Aggrieved , Tamil Mani moved the consumer forum. Before the forum, the company argued that it had acted only based on his proposal for the policy and that it had no opportunity to verify the genuineness of his proposal. However, the Forum rejected the argument.
"The company ought not have accepted the proposal if it was not in order. Besides, if indeed the complainant had prior knowledge of his health related problems, he would have taken a policy worth more than Rs 50,000," the forum said. Directing United India to pay the claim, the forum also ordered the company to pay Rs 10,000 as compensation and Rs 3,000 towards the case expenditure.