A Bandra consumer disputes redressal commission has dismissed the complaint of the son of a deceased against an insurance company after his father who was a bidi smoker died of respiratory failure in 2008.
In its judgement, the commission arrived at the conclusion that there was no deficiency established on the part of the insurer. After carefully considering the arguments and documents placed before it, it said it inferred that the complainant’s father used to smoke which is an important factor in developing the condition of Chronic Obstructive Pulmonary Disease (COPD) that he was suffering from.
The commission’s member Shraddha M. Jalanapurkar and President D. Tulankar said that therefore, the exclusion clause in the policy squarely applies and repudiation of the claim is justified.
Damji Gala had contended in his complaint that similar claims in respect of hospitalisation of his father were sanctioned by the company in 2004. The commission said in this regard that in its opinion earlier claims of similar nature being settled is no grounds to allow the present claim.
The Thane resident had stated in his complaint before the commission that his father had bought a Mediclaim policy in 1997 which was renewed from time to time. In January 2008, when he was 73, he had to be hospitalised in a private hospital with a complaint of high fever and diagnosed with COPD. He was discharged ten days later but died shortly thereafter. He had claimed reimbursement of Rs. 1.5 lakhs that he had spent for hospital expenses and compensation with interest for mental torture as the insurance company had repudiated his claim. He said he had to approach the insurance ombudsman who had also rejected his claim.