The New Delhi District Consumer Disputes Redressal Forum while granting the relief to the woman's legal heirs after her death said the insurance company had arbitrarily denied their claim by taking the "excuse" of 'pre-existing diseases'.
"In our considered view, opposite party (Bajaj Allianz) has simply taken an excuse to deny the just claim, by arbitrarily repudiating it after issuing the policy and taking premium. This is a serious deficiency (of service) and harassment of legal heirs of deceased Lilawati (policy holder).
"We direct opposite party to release the sum of Rs 13.24 lakh equal to USD 26,717.32 (amount spent on treatment in USA) to legal heirs of deceased. We award harassment damage of Rs 50,000," the bench presided by C K Chaturvedi said.
The woman had undergone emergency treatment for abdominal pain in a hospital in the USA, while she was there in October 2008 with her son and had incurred expenses of USD 26,717.32.
As she had bought an overseas medical policy from Bajaj Allianz, she had submitted her claim for the expenses incurred, which the insurance company had rejected on the ground that her discharge summary mentioned pre-existing illnesses of diabetes and high blood pressure.
In its reply to the complaint made by the legal heirs of the policy holder (woman), the insurance company had pleaded that had the pre-existing diseases been disclosed it could have better assessed the risk.
The forum, however, rejected the insurance company's contention saying "the discharge summary shows she was treated in emergency for abdomen pain etc... The discharge summary itself states that it had no relation with pre-existing diabetes... The conditions of overseas medical claim are not in conflict with the findings in discharge summary."
