Oriental Insurance Co Ltd has been directed by a consumer forum here to pay Rs 60,000 over a claim to a policy holder for not fully reimbursing the medical expenses incurred on his treatment for dengue on the ground of pre-existing disease.
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The New Delhi District Consumer Disputes Redressal Forum pointed out that dengue is not pre-existing disease and Oriental Insurance had acted without applying its mind when it deducted Rs 10,000 from the policy holder’s claim on account of pre-existing illness.
“Dengue is not pre-existing disease and could not be subjected to deduction. Opposite party (Oriental Insurance) acted without application of mind and committed deficiency in service.
“Holding opposite party guilty of deficiency in service, we direct it to refund Rs 10,000 amount remaining with it towards hospital expenses and award Rs 50,000 as compensation including interest and litigation cost,” the bench presided by C K Chaturvedi said.
The forum’s order came on a complaint made by Delhi resident and advocate Nau Nihal Singh Rana who had said that he had bought a mediclaim policy for the period from May 13, 2004 to May 11, 2008 for himself and his wife.
During the third year of the policy he had suffered dengue viral fever due to mosquito bite and was admitted on October 16, 2006 at Amar Leela Hospital at Janakpuri here, Rana had said.
He had presented a claim of Rs 24,795, for the expenses incurred on his treatment, but Oriental Insurance had paid only Rs 14,795 after deducting Rs 10,000 from the amount on the ground of compulsory excess deduction for pre-existing disease.
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