Observing that Bajaj Allianz had "arbitrarily" rejected the claim for reimbursement of medical bills on woman's treatment in the USA despite charging the premium, the New Delhi District Consumer Disputes Redressal Forum also directed the firm to pay Rs 50,000 as damages for causing harassment to the husband of the woman.
The woman had died later after claiming reimbursement of money spent on her medical treatment.
"In our considered view, opposite party (Bajaj Allianz) has simply taken an excuse to deny the just claim, by arbitrarily repudiating the claim after issuing the policy and taking premium. This is serious deficiency and harassment of legal heirs of deceased Lilawati.
"We direct Bajaj Allianz to release the sum of Rs 13.24 lakh equal to USD 26,717.32 (medical expense) to legal heirs, the husband of deceased. We award harassment damage of Rs 50,000," the bench presided by C K Chaturvedi said.
The forum's order came on the plea of the legal heirs of the deceased policy holder, Lilawati, who had purchased an overseas medical policy from the insurance firm.
Lilawati, while in the USA in 2008 had undergone treatment and surgery for abdomen troubles for which she had to pay USD 26,717, the Noida-based legal heirs in their plea had said.
On returning to India, the claim was submitted to the firm, which had rejected it saying that as per the discharge summary she had been suffering from "pre-existing" diseases of diabetes and high blood pressure.
The firm had pleaded that if her pre-existing ailments had been disclosed, they could have better assessed the risk.
The bench while terming the defence of the firm as a mere excuse, said "discharge summary itself states that it (her abdominal trouble) had no relation with pre-existing diabetes, which was under control by diet and blood pressure had been treated."
