Insurer told to pay Rs 2 lakh in Amritsar

Posted at: Jul 31, 2017, 1:04 AM; last updated: Jul 31, 2017, 1:05 AM (IST)Firm accuses insured man of concealing his illness history

Amritsar, July 30

The district consumer disputes redressal forum has directed an insurance company to pay Rs 2 lakh to a local resident along with Rs 2,000 as litigation expenses.
Simmi Khurana, a resident of Green Avenue, had filed a complaint against Max Bhupa Health Insurance Company stating that her husband had been renewing insurance cover that he purchased in 2012. She stated that in continuity, the policy was renewed with a sum insured worth Rs 2 lakh in February 2015.
The complainant said in January 2016 her husband suffered some medical problems as he was diabetic. The family spent about Rs 2 lakh on hospitalisation, but the patient died on January 18, 2016. Later, the medical claim was denied stating that her husband was having history of hypertension and diabetes mellitus for 20 years. However, she claimed that the facts were disclosed to the insurer.
Khurana maintained that they had earlier too got medical insurance claims from the company on three separate instances. The company stated that the claim was rightly repudiated as the insured had not disclosed his medical history at the time of purchasing the policy.
The forum observed that the husband of the complainant was continuously insuring himself since 2012 and the opposite party was duty bound to reimburse the expenditure incurred on the treatment duly covered under the policy. The only ground on which the claim of the complainant has been repudiated, has been that the complainant was suffering from hypertension and diabetes for the last 20 years which is prior to the issuance of the insurance policy. Hypertension and diabetes mellitus are not a material disease and it is preposterous to presume that the said disease was pre-existing or that non-disclosure thereof at the time of obtaining the insurance policy amount to concealment, the forum observed.

Insured died last year

Insurance policy holder’s wife says he died while under treatment last year. Rubbishing insurance company’s charge that he concealed information about his problems related to diabetes and hypertension, she maintains that insurance cover was issued despite informing everything about the illness.

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