Saturday, May 31, 2014

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Not mentioning common lifestyle diseases while applying for insurance is not concealing facts and cannot be a reason for rejection of insurance claims, a district forum has observed while citing a state commission order. 

The forum stated it cannot be concealment of facts unless a patient has undergone long treatment and hospitalization days before taking the policy. 

On Friday, the forum directed New India Assurance to pay the medical insurance amount of Rs 2.3 lakh and compensation of Rs 1 lakh to the family of a man hospitalized for cardiac-related ailments in 2007. 

The insurance company had repudiated the claim that the policy holder had concealed his pre-existing ailments before procuring it. 

"The complainant has clearly mentioned that he was a heart patient and this fact was known to the officer of the insurance company. Hence, in our opinion, the rejection of the complainant's claim is unjust and improper," the forum said. 

The policy holder, Kabiru Dhamani, died but his wife and two children filed the complaint before the South Mumbai Consumer Disputes Redressal Forum on June 13, 2008. 

The Dhamanis told the forum Kabiru had revealed he was a heart patient. He had procured the policy in June 2004 and paid a premium of Rs 6,180. 

The family alleged the insurance company was aware that Kabiru suffered from hypertension with diabetes mellitus. In 2006 and 2007, Kabiru was hospitalized and treated for cardiac problems at a Nagpur hospital. 

In July 2007, the family filed the insurance claim which was rejected later. The insurance company said the claim was not admissible due the exclusion clause relating to pre-existing disease. 

Aggrieved, the family filed a complaint before the forum.
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