It is commonly seen that insurance companies at the time of issuance of policy “keep people in the dark” on terms and conditions but use the same to “thwart the legitimate claim” of the insured, a district consumer forum has said while terming the rejection of an insurance claim as “unfounded”. A consumer forum bench, headed by its president K S Mohi, directed Oriental Insurance Company Limited to pay Rs 2,02,851, along with Rs 5,000 as compensation, to central Delhi-resident Yashvir Singh.
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The forum also held that the repudiation of the claim of Singh was highly unjustified, unwarranted and unfounded, therefore, it amounted to deficiency in service.
“It is commonly seen that the insurance companies at the time of issuance of policy keep the people under dark and do not apprise them of any terms and conditions, so that the insured may exercise his right as to whether he should go for insurance or not.
“But once the claim is filed the insurance companies would immediately come out with all kind of defenses including the terms and conditions to thwart the legitimate claim of the hapless insured,” the forum said.
On the insurance firm’s submission that the claim was rejected relying on certain clauses on terms and conditions of the policy, the forum said that unless terms and condition have been supplied to the complainant before taking a policy, exclusion clause cannot be enforced.
According to the complaint filed by Singh, he took a mediclaim policy for the period from June 30, 2014 to June 29, 2015. It is alleged that the annual premium of Rs 24,268 was regularly paid by him and accordingly the policy is in continuous operation for the last four years.
On May 25, 2015 the mother of the complainant fell ill and was admitted to a hospital in Rajinder Nagar here for which the hospital raised a bill of Rs 2,02,851, but the insurance company rejected the claim.