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Tamil Nadu: Insurance Company to pay compensation for denying mediclaim


Tamil Nadu: Insurance Company to pay compensation for denying mediclaim

Srivilliputtur: In a case filed by one V.K. Beemaraja against the Oriental Insurance Company for non-payment of his mediclaim, Virudhunagar District Consumer Redressal Forum has directed the insurance firm to settle the amount of Rs. 16,669.20 for his cataract surgery, along with a compensation of Rs. 10,000 and Rs. 3,000 for legal expenses and mental agony caused to the complainant party.

The forum has directed the company to pay the amount within a period of one month, failing which the company would have to pay an increased amount subjected to 6 percent interest till the date of payment.

Beemaraja had filed a case with the local consumer redressal forum, claiming that the insurance company has refused to pay the incurred amount for his cataract surgery that took place in a city hospital.

A Hindu report stated that the company rejected the claim on grounds  that the policy holder had renewed the policy only after a lapse of three days, and as the renewal was not continuous, it would be termed as a fresh one.This disqualified him from receiving any claims said the Oriental Insurance Company.

Also, “As per the policy conditions, cataract surgery are not payable for the first two years. If the policy is renewed continuously without a break it is payable for 3rd year,” it claimed.

During the hearing, the forum chairman, V. Balasundarakumar, stated quoting a previous Supreme Court verdict over a similar case, that the policy in connection can only be considered as a continuous one as during the renewal of the term, the company had not taken any fresh proposal papers and documents of the holder, which makes it liable not to be termed as a fresh one.



Source: With inputs
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