A consumer forum here has directed New India Assurance Company Ltd to pay over Rs 3.5 lakhs to a man who was "arbitrarily" denied mediclaim for allegedly hiding his pre-existent disease.
The New Delhi District Consumer Disputes Redressal Forum, presided by C K Chaturvedi, directed the insurance company to pay Rs 3,57,857 to Gurgaon resident Rajiv Chanana.
"....It is established that opposite party (company) has acted, without application of mind, and blamed complainant for material suppression of facts," the forum said.
"....OP (opposite party) is directed to refund Rs 2,87,857....We also award Rs 45,000 for harassment and deficiency and Rs 25,000 as litigation expenses," it said.
According to the complaint by Chanana, he got admitted in hospital while he was under the insurance company's policy scheme, taken for the period of February 1, 2009 to January 31, 2010, and intimation was given to the company.
He approached the company after 15 days of claim submission regarding its status but got no reply from it. He exchanged several mails and correspondence but the firm failed to settle his total claim of Rs 2.87 lakh, the complaint said.
The insurance company submitted before the forum that Chanana supplied details of his illness of 1995 to 2005, while taking policy of 2009-2010.
Chanana, however, told the forum that policy of 2009-2010 was in continuation of an earlier policy.
"It appears that OP has disputed all the facts in filmy fashion under the shadow of pre-existing diseases referring illness (from) 1995 to 2005 without supporting any documents of 1995 whereas fresh policy was enforced during 2009 to 2010, after lapse of 9 years, which is a clear case of deficiency and unfair trade practices on their part.
"The OP arbitrarily denied claim without any valid reason except to take shelter of pre-existing diseases which forced complainant to enter into litigation for own justice," the forum said.
