The district consumer disputes redressal forum has directed an insurance company to pay Rs 3,02,679 to a local resident along with 9 per cent interest from the date of filing of complaint (April 2013).
The company has also been directed to pay litigation expenses of Rs 2,000.
Earlier Achala Khullar, a resident of the Putlighar area, had filed a complaint against Oriental Insurance Company, stating that her husband Vipan Khullar had obtained a medical insurance policy under which she, her husband and child were insured for Rs 5 lakh each.
She said her husband was admitted to a private hospital where his kidney was transplanted.She said as she had donated the kidney and was also hospitalised, she suffered from stroke after she underwent nephrectomy.
She stated that the said stroke had no relation with the survival procedure. She said she had spent an amount of Rs 3,02,679 on her medical treatment.She said when she submitted the claim, it was repudiated without assigning any reason.
The opposite party in its reply submitted that as per the policy terms and conditions, the expenses of donor, in case of organ transplant, need to be paid from the sum insured of the recipient.
The company stated that as the husband had already exhausted his sum insured, so some of the expenses could be paid. It stated that the husband’s claim was Rs 4.38 lakh.
The forum observed that the doctors who treated the complainant categorically certified that the patient suffered a stroke after she underwent nephrectomy and the stroke has no relation with the surgical procedure this patient underwent.
It stated that the insurance company could not produce any certificate to rebut the certificate issued by treating doctors. It stated that as the complainant was also entitled to a sum insured of Rs 5 lakh, the company could not deny the claim. — TNS
Curated from Insurance firm told to pay relief