Hyderabad: Acting on a customer’s complaint, the state consumer forum has penalised Star Health and Allied Insurance for cancelling a policy on the grounds that the customer did not inform them about an existing ailment at the time of disclosure.
The complainant, 73-year-old Gunda Rajalingam, had stated that he was a holder of the Senior Citizen Red Carpet policy from March 10, 2012-15, and that he had paid an annual premium of Rs 15,000 for two years for the policy, which was worth Rs 3 lakh.
Rajalingam was admitted to Vishwas Super Speciality Hospital in Hanamkonda for acute GEC kidney injury and hyponatremia (low sodium level in the blood) and severe bronchitis, and discharged on September 18, 2014, his medical bill amounting to Rs 70,000.
After being discharged, he approached the insurer seeking a refund of expenses, but was rejected owing to “non-declaration of pre-existing diseases”, with the insurer contending that the complainant ought to have disclosed his ailments before he was admitted to hospital and that he had deliberately hidden facts about the treatment he had undergone before obtaining the policy.
Having gone through the patient’s existing medical records, the forum found that the patient has a history of shortness of breath and hypertension but not of a blood clot as the insurer had stated.
The forum noted that cancelling the policy was unjust and that a blood clot was not a disease but an injury. The forum said there being a deficiency in service on the part of the insurer, the complainant is to be paid Rs 70,000 plus interest at the yearly rate of 7.5 per cent from 2015.
