Hyderabad: Finding fault with Oriental Insurance Company for treating diabetes and hypertension as heart disease and for refusing a claim for reimbursement of medical expenses, the state consumer commission upheld the order of the forum of district consumers and ordered the insurance company to pay Rs 2.5 lakh to the policyholder within a month along with a fee of Rs 3,000.
A bench of commission chairman, Judge MSK Jaiswal, members Meena Ramanathan and K Ranga Rao made the order while rejecting an appeal from the insurance company.
According to claimant Vanga Harischandra Reddy of Jillelaguda in Ranga Reddy district, he had taken out a mediclaim policy in 2013 for Rs 5 lakh and paid annual premiums for 2013 and 2014. After undergoing bypass surgery in May 2014 which cost him Rs 4.5 lakh, his claim was rejected by the insurance company who claimed he had suppressed the fact that he had heart disease.
The state board checked the records and concluded that the patient’s medical records showed only that he had diabetes and hypertension.
“The petitioner developed a heart condition a year after taking out the insurance policy and therefore we cannot say that he has cleared any past conditions related to his heart,” the bench said.
A bench of commission chairman, Judge MSK Jaiswal, members Meena Ramanathan and K Ranga Rao made the order while rejecting an appeal from the insurance company.
According to claimant Vanga Harischandra Reddy of Jillelaguda in Ranga Reddy district, he had taken out a mediclaim policy in 2013 for Rs 5 lakh and paid annual premiums for 2013 and 2014. After undergoing bypass surgery in May 2014 which cost him Rs 4.5 lakh, his claim was rejected by the insurance company who claimed he had suppressed the fact that he had heart disease.
The state board checked the records and concluded that the patient’s medical records showed only that he had diabetes and hypertension.
“The petitioner developed a heart condition a year after taking out the insurance policy and therefore we cannot say that he has cleared any past conditions related to his heart,” the bench said.