The Central Mumbai District Consumer Forum has penalized Bajaj Alliance General Insurance for wrongly rejecting an insurance claim and ordered the company to pay the customer the full amount of Rs6.69 lakh.
The panel also directed the firm to pay an additional Rs10,000 as compensation for the mental agony and Rs5,000 towards litigation costs.
The case relates to a travel insurance policy obtained by Bhupinder Singh Kumar in 2012. The man paid Bajaj Alliance a premium of Rs44,000 for the policy taken for the period from May 4, 2012 to May 26, 2012, when he made a trip to the US.
"While in New York, he developed chest pain and palpitation and was in hospital on May 14 and 15, 2912," reads the complaint.
Kumar, who is a resident of Prabhadevi, informed the insurance company about the medical expense owing to his poor health condition and requested the firm to pay the amount directly.
But he was surprised when the insurance firm refused to pay the amount. The firm stated that the illness was due to pre-existing cardiac disease he suffered in 1997 and that the policy did not cover medical expenses for a pre-existing disease.
Kumar told the insurance company that the illness he suffered in New York was not related to a pre-existing disease. But the firm refused to change its position and would not pay the medical bills. So he approached the forum.
The forum went through the evidence on record including the medical certificate issued by the New York hospital which clearly stated that the illness suffered by Kumar was not due to any pre-existing disease.
The forum said this was enough to prove that repudiation of the claim by the insurance company was unreasonable. It directed the company to pay the claim amount along with compensation.
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