Insurance firm asked to cough up claim for heart ailment

Rejecting the stand of an insurance company, a consumer forum has granted claim to a complainant while holding that he had neither concealed his illness nor undergone an operation before taking the policy for any specific ailment which can be treated as pre-existing disease.
Complainant Narendra Ishwarlal Thakkar, a resident of Damani Estate in Naupada locality of Thane city, informed the forum that he had taken the Parivar Mediclaim Insurance Policy from the National Insurance company, which was valid from August 2007 to August 2008.
In May 2008, he suffered a heart attack and was admitted and treated at Wochkardt hospital for about ten days for which he incurred an expense of Rs 2,78,730.

Thakkar filed a claim for the expenses with the insurance company, which rejected it stating that the claimant had a pre-existing disease of blood pressure for two years which resulted in the heart attack and that he had hidden the ailment from the company while taking the policy.
However the claimant argued that he never had the blood pressure problem and had never hidden it from the company. He also told the forum that he had diabetes earlier and had paid additional premium for the same.
He sought the claim of Rs 2,78,730 along with interest at 10 per cent per annum compensation of Rs one lakh and Rs 10,000 legal expenses.

In its recent order, Thane District Consumer Redressel Forum president Umesh Jhawalikar and member N D Kadam stated that from the documentary evidence it is not proved that the complainant was taking any treatment for heart ailment.
The forum, referring to earlier orders, stated that the claimant was neither admitted to the hospital earlier for undergoing operation for any specific disease which can be treated as pre-existing disease, nor had he concealed the said fact while taking the policy.
Hence, the insurance company erred in rejecting his claim, the forum ruled, while asking it to pay the amount claimed by the victim along with a compensation of Rs 50,000.