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Insurance firm to pay Rs.1.2 lakh to elderly man
The Hindu, June 16, 2019

For indulging in unfair trade practices

A district consumer disputes redressal forum here has directed United Insurance Company to compensate a senior citizen by paying over Rs.1.20 lakh for not revealing the terms and conditions pertaining to disclosure of pre-existing diseases to the complainant beforehand.

Holding the insurance firm deficient in service, the consumer panel held, “We hold the [firm] to be grossly deficient and indulging in unfair trade practices as having taken the premium from the complainant regularly and when the claim was raised by the complainant, the [firm] gave false and frivolous excuses to deny the claim of the complainant.” The directions came when complainant Harvinder Pal Singh moved the consumer forum challenging the repudiation of a claim by the insurance firm.

It was alleged that the company rejected a claim of over Rs.97,000 raised by a hospital where the complainant got treated. Stating that the policy availed by the complainant was valid at the time of the treatment, the consumer panel while noting the complaint observed, “The complainant, being a senior citizen and aggrieved due to the denial of rightful claim, approached this forum.”

‘Waiting period’

The insurance firm however contended that the claim was rejected on the terms that “there has to be a waiting period of 48 months in the cases of pre-existing diseases”.

Dismissing the firm’s contentions put forth by the insurance company, the district forum said, “It is noticed that the ‘waiting period’ is left blank in the declaration [signed by the complainant]. Further, the [firm] has nowhere in its pleadings stated that the copy of terms and conditions were supplied to the complainant. Hence, it is affirmed that the complainant was not told or informed about the waiting period.”

While directing the insurance firm to pay the claim of Rs.97,000 raised by the complainant, the consumer forum directed an additional compensation of Rs. 25,000 for the inconvenience caused to the complainant.

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