Indore (Madhya Pradesh): The consumer court has directed an insurance company to pay Rs 1,77,570 and interest at the rate of 9% from the date of discharge within one month to the complainant in a case of a medical insurance policy claim.
The complainant has also been awarded a compensation of Rs 10,000 as well as Rs 2,000 for the expenses from the day of the decision and in case of failure of the insurance company to make the payment within a month, it will have to pay the amount with 6% interest.
According to information, Anita Mukesh Kumar took a medical policy of Rs 2,00,000 for a year.
Meanwhile, as her health worsened she visited a doctor and as medication did not benefit her she was admitted to a private hospital on March 24, 2019. The complainant was discharged on April 3, 2019. She incurred a treatment cost of approximately Rs 1,77,570.
Despite notifying the insurance company about her admission and submitting the claim application post-discharge, repeated contacts yielded no payment. On May 7, 2019, the complainant's claim was unjustly cancelled according to a letter received.
The complainant held a life insurance policy with a sum insured of 2,00,000, including coverage for serious illnesses, obtained when she was above 50 years old.
The insurance company contended that the complainant failed to disclose pre-existing conditions such as diabetes, hypertension, and hepatitis before obtaining the policy, asserting that she concealed vital information during the application process.
In response, the doctors from the private hospital provided a certificate stating that the complainant was treated for Pituitary Macroadenoma, a condition unrelated to her pre-existing diseases of type-2 diabetes and hypertension. The doctor affirmed there was no direct link between the treated disease and the complainant's previous health conditions, dispelling any association with diabetes or hypertension during the treatment. The court on the grounds of the evidence decided in the favour of the complainant.