Hyderabad: The consumer forum has indicted Star Health Insurance for deficiency of service for denying medical insurance and ordered it to pay the sum and cost to a complainant. Mr G. Srinivas from Mahbubabad had moved the forum stating that he and his family had taken a family health policy with Star Health Insurance on November 24, 2009.
The last renewal period ended on November 18, 2013, for the policy with sum assured of Rs 2.1 lakh — basic floater sum insured of Rs 2 lakh and a bonus of Rs 10,000.
To renew the policy, Mr Srinivas sent a cheque for Rs 7,612 drawn on the State Bank of India. It was returned to Mr Srinivas citing a technical problem even though his bank account had sufficient funds.
Star Health Insurance cancelled the policy as a result of non-payment. It was renewed after Mr Srinivas paid Rs 7,612 in cash.Mr Srinivas took ill in November 2013, suffering from with extreme pain on his right flank. He underwent surgery and was discharged on November 25. He spent Rs 54,944 from his pocket.
After discharge, Mr Srinivas made a claim for insurance but Star Health stated that he did not have a policy.
The insurer said Mr Srinivas’ cheque had been dishonoured, leading to cancellation of the policy for non-payment of premium.
The company contended that it had not received any cash payments from Mr Srinivas. Star Health said it had repudiated Mr Srinivas’ claim on the ground that the treatment had taken place after the expiry of the policy.
The forum stated the insurer’s claims were meant to mask its deficiency of service as the records showed that the premium was paid in cash. Moreover, Mr Srinivas’ bank account had sufficient balance and he couldn't be blamed for a system failure that affected payment of the premium through a cheque.
The forum directed Star Health Insurance to pay Rs 54,994 with an interest of 7.5 per annum from November 23, 2013, till the date of realisation along with Rs 10,000 towards costs....