January 2, 2009 - Filed Under Reliance Insurance
The District Consumer Disputes Redressal Forum has directed Reliance General Insurance Company to pay Rs 1 lakh as mediclaim to an advocate member of the High Court Lawyers Public Charitable Trust. The company has also been directed to pay Rs 10,000 as compensation for causing mental agony and harassment.
According to the complaint, filed by the trust, 1682 advocate members of the trust including complainant Sanjay Nagpal were insured with Reliance Insurance against a premium of Rs 36, 56, 30. They had availed of the Group Mediclaim Insurance Policy, which was valid upto August 15, 2008.
Nagpal along with his spouse and two children were insured for a mediclaim policy to the tune of Rs 1 lakh.
In January last year, Sanjay had a fall in the premises of the Punjab and Haryana High Court and was taken to a dispensary where he was diagnosed with hypertension. Thereafter, he visited the Fortis Hospital in Mohali for a medical checkup and was advised an MRI, the results of which were normal.
His angioplasty results, however, revealed a double vessel disease. After getting discharged from the hospital, he submitted a mediclaim of Rs 1 lakh for reimbursement to the insurance company. The claim, however, was rejected by the company.
In its reply, Reliance Insurance said that the complainant had first moved an application for cashless hospitalisation which was turned down as it was found to be a case of a pre-existing disease.
After discharge from the Fortis Hospital, he had filed a claim. The discharge history revealed that it was a pre-existing disease, thus the claim was rightly repudiated.
The forum ruled that at the time of taking the policy or filling the proposal form thereof, the advocate was not aware of any disease or the symptoms as was being alleged by the insurance company. The panel of medical practitioners constituted by the company had also not made any such observation and as per the agreement, the advocate was liable to get the claim.