Oriental Insurance Company Limited has been directed by the UT Consumer Forum to reimburse the medical expense of an insured man,and compensate him with Rs 50,000 for denying him a legitimate insurance claim on the basis of pre-existing diseases,a condition which the company failed to prove on record.
Manmohan Singh,a resident of Sector 19,and his wife had obtained a mediclaim policy,Happy Family Floater Policy,from the company in 2009,valid till September 2010,which covered hospitalisation expenses of all his family members.
In September 2010,on account of sudden chest pain,Singh visited a hospital in Mohali and subsequent tests were conducted,which revealed a heart-related medical condition,referred as single vessel disease for which he was admitted to the hospital.
The insurance company claimed that as per the complainants statement and hospital records,he had a history of diabetes and hypertension,related to his present medical condition. But these were not disclosed by him in the proposal form of the policy,and hence,the claim could not be granted by them.
However,the insurance company could not prove,through valid documents,that the complainant suffered from these ailments before the policy was issued. The complainant claimed that a statement referred to by the insurance company,recorded in January 2011,was executed under pressure,threat and constrained circumstances and was not supported by his affidavit. On its failure to provide the evidence to support its claim,the insurance company has been directed to pay the medical expenses of Rs 2,95,591 incurred by the complainant and to additionally pay a compensation of Rs 50,000. Also,the company is to bear the litigation costs of Rs 15,000.