The Vadodara Consumer Disputes Redressal Commission has ruled that even if a woman is married, she can still be eligible for an insurance claim under a policy purchased by her father. The commission ordered the New India Assurance Company Ltd to reimburse Bharat Chaudhary the amount he claimed for his daughter's medical treatment.
In 2009, Chaudhary had bought a floater mediclaim policy for his family members and had been renewing it annually. In 2021, his daughter Ankita required medical treatment for a urinary tract infection and was admitted to a private hospital on Waghodia Road. The treatment cost amounted to Rs 65,000, which Chaudhary claimed from the insurance company.
However, the claim was initially rejected by the insurer, stating that Ankita was married during her medical treatment and thus not covered under the floater policy's terms and conditions. The insurer argued that Chaudhary had not informed them about Ankita's marriage while renewing the policy. Dissatisfied with the rejection, Chaudhary filed a complaint with the consumer forum in October 2022.
Upon considering the arguments from both parties, the consumer forum concluded that the policy clause does not explicitly exclude coverage for a daughter if she is married.
"Clause 1 just says that the policy would cover dependents from three-month old baby to 25 years old offspring who are dependent on their parents," the consumer forum said.
The forum further noted that the insurance company had previously approved and settled a claim filed by Chaudhary for Ankita's treatment of dengue fever in September of the previous year. In light of this, the forum emphasised that if the daughter's marriage was not a concern in the second claim, it should not be raised as an issue in the current claim.
"The insurer wrongly rejected the insurance claim by giving the excuse that the complainant's daughter is married," the forum observed and directed the insurer to reimburse Rs 65,846, along with 9% interest from the date of claim rejection. Additionally, the insurer was instructed to provide Rs 2,000 each as compensation for mental harassment and legal expenses to the complainant.