This can happen to you, insurance company rejects Mediclaim for cancer treatment, consumer court gives a blow, finally 3 lakhs…

• Insurance company rejects Mediclaim for cancer treatment
• Consumer Court gave such a blow

The District Consumer Court at Ahmedabad has dealt a major blow to United India Insurance Company Ltd. The court ordered the company to pay a claim of Rs 3 lakh to a policyholder for cancer treatment with 7% annual interest. But what actually happened”text-align: justify;”>The decision taken by the insurance company to reject the claim has been declared arbitrary, illegal and invalid by the court. The order was passed by the District Consumer Disputes Redressal Commission, Ahmedabad, on a complaint filed by Consumer Education and Research Center (CERC) and policyholder Upendra Thakkar.

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What is the whole matter?

According to the complaint, Upendra Thakkar’s wife was treated for bone marrow cancer between October and November 2018 at a total cost of Rs 17.3 lakh. Thakkar claimed a reimbursement of Rs 3 lakh under his mediclaim policy. But the insurer rejected the claim, saying the case involved genetic diseases and stem-cell implantation or surgery, which were not covered under the terms of the policy.

Why did the court warn?

During the hearing, the Consumer Commission found that the insurance company did not appear for the final hearing, nor did it submit any documents or terms and conditions before the court that could support the decision to reject the claim.

The court clearly stated that if the company cites any rule to reject the claim, the onus is on the company to prove it. The court also noted that the complainant had been renewing the policy since 2008. As no evidence was submitted by the insurance company, the court refused to accept the claim.

Also orders interest and damages

The commission directed the insurance company to pay interest at the rate of 7% per annum on the sum insured of Rs 3 lakh from the date of complaint (February 4, 2020) till the date of payment. In addition, the policyholder was ordered to pay compensation of Rs 2,000 for mental and physical torture and an additional Rs 2,000 towards court costs. The insurance company has to comply with this order within one month.

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