Insurance firm to pay ₹20 lakh for not settling mediclaim

JALANDHAR: District consumer dispute redressal forum, Jalandhar, has directed Religare Health Insurance Company Limited to pay overseas medical insurance claim of ₹20 lakh to a Jalandhar man for failing to settle the claim. It further directed that the entire compliance be made within one month from the date of receipt of the copy of the order.

Harwant Singh, Jalandhar, in his complaint on October 30, 2018, said that his daughter-inlaw had purchased a health insurance on behalf of him and his wife Parvinder Kaur and they were insured for $1,00,000 (each) for overseas mediclaim insurance policy under “Explore Canada” for the period April 12 and October 7, 2018.

Singh proceeded to Canada after obtaining the policy. He complained of uneasiness and got himself admitted to a hospital in Canada. He underwent treatment there for eight days and also consulted physician and had taken some medical tests that allegedly cost him Canadian dollar 38,040.

However, when his wife submitted medical health insurance claim for reimbursement of the expenses incurred, his claim was rejected by the company claiming that the complainant did not disclose material facts of hypertension and hyperlipidemia at the time of taking the policy.

Harwant Singh pleaded before the forum that the total expense on his treatment cost him more than ₹20lakh and he only wants the insurance firm to ₹20 lakh as claim.

The forum observed that Religare failed to establish that there was any pre-existing disease and moreover it is settled law that diabetes and hypertension are normal and cannot be termed as concealment of pre-existing disease.