Insurance Co. To pay around Rs 1L for breach of obligations

A consumer forum here has asked Oriental Insurance Company Ltd to pay around Rs one lakh mediclaim to a man, while expressing "shock" over breach of obligations by the firm.
New Delhi Consumer Disputes Redressal Forum, presided by C K Chaturvedi, noted that the insurance company "deliberately acted with mala fide intention and deserved to be burdened with heavy compensation to deter it".
Forum's bench, also comprising its members S R Chaudhary and Ritu Garodia, asked the firm to pay Rs 96,179, including Rs 50,000 as compensation and Rs 20,000 as litigation expenses to Delhi resident Gian Chand Hans for deliberately violating policy terms by not paying Rs 26,179, which he had spent during his treatment.

"We are shocked at the breach of obligations by insurance company after giving policy and collecting premium. It has deliberately acted with mala fide intention and deserved to be burdened with heavy compensation to deter it.
"We direct Opposite Party (Insurance Company) to pay claim of Rs 26,179...And pay Rs 50,000 as the compensation for deficiency and deliberate violation of policy and Rs 20,000 for litigation expenses," it said.
Hans had told the forum that he was covered under mediclaim insurance coverage of the firm from last 15 years and was lastly insured with effect from February 19, 2006 to February 18, 2007, under the domiciliary hospitalisation.

Hans was admitted to a hospital in 2006 where he was diagnosed and treated for vertebrobasilary insufficiency, which is a condition characterised by poor blood flow to the back portion of the brain, he said.

He claimed that he spent Rs 26,179 in his treatment, and later sought claim from the company, which was denied.
Therefore, he filed the complaint with the forum, he said.
The company, however, contended before the forum that the claim was denied on the ground that hospitalisation was only for d iagnostic purpose and not for treatment.