The UT District Consumer Forum has slapped a penalty of Rs 35,000 on an insurance firm for wrongfully repudiating the mediclaim of a city resident. Also, the Forum directed the Oriental Insurance Company to reimburse the claim amount of Rs 1,24,880 saying the repudiation was “totally unjustified and illegal”.
Parshotam Tandon, a resident of Sector 11, was provided a mediclaim policy on opening an account with the company in 2012. While he paid the premiums for the policy that would entitle him a refund of Rs 5 lakh for treatment of any disease, Tandon claimed the company repudiated his claim on flimsy grounds.
In 2013, Tandon was diagnosed with 70 per cent blockage in one artery and was operated for angioplasty and stenting at the PGIMER.
After he was discharged, Tandon approached the insurance company for reimbursement of his mediclaim. However, his claim was declined saying Tandon was suffering from the disease at the time of proposal of the policy. Also, the firm said the complainant had a family history of the disease and the hypertension caused by the disease was excluded from the policy.
The contention of the company, however, found no ground in the Forum where the complainant proved them wrong with a certificate issued by a PGIMER doctor. He proved the hypertension was not related to the disease and he had undergone angioplasty in the hospital. Also, it was proved the operations were not surgical processes as contended by the company.
The Forum has ordered the firm to compensate the complainant for causing him mental agony within a month, failing which it would be held liable for paying the total amount with a 12% interest.