Taking strong view of wrongful repudiation of mediclaim policy on the ground of concealment of pre-existing ailments, a city consumer court has asked the Oriental Insurance Company to cough up the claim amount including compensation of Rs 93,369 to a consumer whose insured wife died of an accidental fall.
"Merely because the respondent (insured) was suffering from arthritis for the last 20 years did not mean that she did not suffer the injury due to accidental fall. Furthermore, by no stretch of imagination, right hip joint replacement can be termed as pre-existing disease," said Justice J D Kapoor, president of the State Consumer Disputes redressal Commission.
Pulling up the OIC for denial of claim amount to R C Nigam, who was the joint policy holder with his deceased wife, the commission rejected it's appeal, preferred against the order of a District Consumer Forum, and asked it pay up the amount within a month.
Giving credence to the Jaipur Golden Hospital's report, where Malati Nigam was admitted after her fall and underwent hip replacement surgery, that the patient was suffering from 'injury in hip region due to fall', the commission held the company guilty for 'deficiency in service'.
The District Forum in its order dated April 28, 1998 had asked the company to pay the medical expenses, compensation and cost of litigation to complainant Nigam and termed the repudiation wrongful.
Declining to interfere with District Forum's verdict, the Commission observed, "Arthritis and other such diseases are normal wear and tear of human life" and it does not fall under the exclusion clause of the policy.