Dismissing an order of the district forum,the UT State Consumer Disputes Redressal Commission today directed United India Insurance Company to pay Rs 88,938 towards the cost of treatment to a city resident.
The complainant,Surjit Singh Rekhi,had taken a hospitalisation and domiciliary hospitalisation benefit policy from United Insurance Company in 2000 for a period of one year,which was extended up to March 24,2006.
The complainant said he availed the policy for the whole intervening period,except six months,which was a result of not being timely informed by the insurance agent.
He was admitted in Arya Hospital,Manimajra for Gastrointestinal (GIT) Bleeding,from where,he was referred to Fortis Hospital. He was ultimately discharged from Fortis in March 2005.
It was averred that Surjit filed his claim for Rs 88,938 along with the requisite bills but his claim was repudiated on grounds that his disease was a pre-existing disease.
The company,in its reply,said the complainant contracted the disease during the period when he was not insured and thus denied the claim.
The district forum recorded that since the mediclaim insurance cover was taken by the complainant for the first time in 2000 and all renewals made thereafter had were not continuous,the complainant was not entitled to any benefits.
Aggrieved by the order,the complainant then appealed to the commission.
The commission stated that as no cogent or reliable evidence had been placed on record by the insurance company to prove that the complainant was aware of the problem or had shown any symptoms of the same.
United India insurance to pay claim
Upholding an order of the Yamunangar district forum,the UT State Consumer Disputes Redressal Commission has directed the United India Insurance Company to pay Rs 4.08 lakh claim to a factory owner. The complainant,owner of Neelgiri Wood Crafts in Yamunanagar,that water entered in his factory from a drain said July 2000,leading to its accumulation and extensive damage to the machinery and stocks. It was alleged that the claim was never paid.The company replied that the claim was rejected on the ground that there was no waterlogging on the day the surveyor visited the site. The state commission ruled that the surveyor was silent about the drain and did not examine the witnesses.