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Risk firm told to pay Rs 10.5 lakh to family of deceased

The commission in its order held that the claim of the complainant was wrongly repudiated by the firm which caused a lot of mental stress to the family.

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The 71-year-old claimant died while the case was pending; the forum has directed the insurance firm to compensate his family
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The state consumer dispute redressal commission has directed the National Insurance Company to grant compensation to the family of a 71-year-old deceased who suffered cardiac issues while in the United States of America in the year 2000.

The commission in its order held that the claim of the complainant was wrongly repudiated by the firm which caused a lot of mental stress to the family.

Churchgate resident J M Bhandari had purchased an overseas mediclaim policy for a period of 60 days. On July 15, 2000, he flew to the US and, within a period of 10 days, had to be admitted to a hospital there for a heart ailment. Doctors advised him to undergo angiography, which he did. The total medical expense came up to $16,651.23, or around Rs 7,82,108.

When Bhandari returned to India, he sought compensation from the firm, but his claim was rejected on the grounds that the insurance norms specifically stated that cardiac diseases were not covered under the policy.

The complainant then approached the commission seeking compensation, but before the case could arrive at a conclusion, he died. His legal heirs — his wife and son — then pursued the matter.

In their submission, they said the insurance firm had scratched out the no-claim -for-cardiac-issues condition while selling them the policy; the clause was originally present in the printed norms. Hence, they claimed, they were eligible for compensation. After going through the evidence, the commission held that the claim was wrongly repudiated.

The commission asked the firm to reimburse the total medical expenses incurred by the family according to the new dollar rates, (Rs 10,58,352) along with an additional amount of Rs six lakhs as a compensatory amount.

The dispute 

  • Churchgate resident J M Bhandari had purchased an overseas mediclaim NIC policy. 
  • In 2000, he flew to the US and had to be hospitalised for a heart ailment. 
  • Firm denied his claim saying cardiac diseases were not covered  
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