Vijayawada: The Consumer Forum of Krishna district at Machilipatnam has ordered ICICI Prudential Life Insurance to pay Rs 2 lakh towards insurance claim and Rs 5,000 for causing mental agony and another Rs 5,000 for the expenses of a complainant.
Yellani Dharma Rao, a native of Machilipatnam purchased an insurance policy with the insurance company on December 10, 2008. He availed treatment for his ailments in 2013 and claimed the amount under the insurance policy.
However, the company made only part payment saying that the remaining amount was not covered under the insurance policy. Following the rejection of the claim, Mr Rao approached the Consumer Forum at Machilipatnam and lodged a complaint.
The insurance company in its arguments first said that the complaint was time barred, as the complainant did not filed any objections within the free look period of the issuance of the policy.
It also defended the rejection of medical claim saying that the policy was only for hospital care but the complainant has submitted various cash memos pertaining to purchase of medicines and test reports in violation to the terms and conditions of the policy.
However, the Consumer Forum found that though the complainant did not raised any objections in free look period the policy was still valid. The Forum headed by its president P Mohan Rao, in its order said that the insurance company has failed to substantiate the evidence to prove that the claim was not covered under the terms and conditions.
The Consumer Forum observed that the rejection of claim comes under deficiency of service and ordered ICICI Prudential Life Insurance to pay the claim amount of Rs 2 lakh with 6 per cent interest from the date of the complaint and Rs 5,000 for causing mental agony to the complainant. The Forum also ordered the company to pay Rs 5,000 in costs to the complainant.
