Consumer forum denies medical claim due to Delay in informing insurance firm

A consumer forum has denied medical insurance claim to a man, noting that the insurer was informed after a delay of five months about the injuries. North Delhi District Consumer Disputes Redressal Forum, presided by Babu Lal, rejected Hisar resident Suresh Cander's mediclaim of Rs 48,795 filed against Oriental Insurance Company Ltd.

The forum noted the firm's submission that there was a delay of intimation of five months whereas it should have been intimated within seven days of the incident.

"We hold that since there was inordinate delay in informing the insurer about incident, therefore, repudiation cannot be said to be unjustified nor it can be said that there was any deficiency on the part of Opposite Party (company).

Complaint is accordingly dismissed," the forum said.

Cander had told the forum that he had taken a Nagrik Surkasha Mediclaim policy for the period August 10, 2005 to August 9, 2009 on payment of Rs 337.

In December 2006, he met with an accident in Unnao district of Uttar Pradesh and received injuries. He was shifted to Kanpur and remained in hospital till January 3, 2007. He filed a claim with the insurance company for reimbursement of the amount which, however, was repudiated by it.

Aggrieved by this, he approached the forum seeking direction to the firm to pay a sum of Rs 48,795 as expenses he had incurred during the treatment, apart from other costs and compensation.

The company contended before the forum that Cander was admitted in hospital on December 18, 2006 and was discharged on January 3, 2007. However, the papers were submitted to it only on May 17, 2007 for reimbursement.

The claim was denied due to delay in intimation to the company as per the policy conditions, it said.