Firm asked to pay Rs 64K for denying eye treatment claim

A consumer forum here has asked an insurance firm to pay Rs 64,000 to a man for denying his insurance claim in respect of the cataract operation and treatment of his 9-year-old son.
New Delhi District Consumer Disputes Redressal Forum, presided by C K Chaturvedi, asked the United India Insurance Co Ltd to pay the amount to Delhi resident Neeraj Handa as it held it guilty of deficiency in service.
"We have considered the claim and find that firm has failed to produce the terms and conditions of policy issued to complainant (Handa) nor produced any evidence in support of explaining such terms and conditions to complainant.

"Firm has also failed to produce any positive evidence to suggest or prove that the son of complainant was suffering from congenital eye disease. The burden of proving both the facts was on the firm, which it has failed to discharge," the forum said.
"After hearing both the parties and considering evidence on record, we hold firm guilty of deficiency and direct (it) to pay Rs 44,000 incurred on treatment... And pay Rs 20,000 as compensation for deficiency, including litigation charges," it said.
Handa had told the forum that his son developed a problem in his eyes in May, 2010, and was taken to an eye hospital, where doctors planned two operations on him.

He said that he spent Rs 44,000 on the operations and submitted the claim with the insurance firm as his entire family had taken health insurance policy from it.
However, the firm repudiated the claim, following which he approached the forum.
The firm had told the forum that Handa's son was a afflicted by a congenital disease which was not covered under the policy.