|Warning to Insurance
June 06, 2006
NEW DELHI: In a stern warning to insurance companies and doctors on their panels,
a consumer court has ruled that medical policy claims cannot be rejected on flimsy grounds such as non-disclosure of pre-existing diseases.
The State Consumer Commission gave this direction while awarding a Rs 2 lakh compensation to a woman with a hip ailment whose claim was denied by an insurance firm.
"We advise doctors on the panel of insurance companies to first equip themselves with basic knowledge (about the case in question)...before giving their opinion, instead of toeing the line of their masters to remain on the panel," said State Consumer Commission president J D Kapoor and member Rumnita Mittal.
Issuing directions to insurance companies not to harass policy- holders on issues relating to previous treatment of a particular ailment, the commission said: "In our view, the consumer is not entitled to any claim only if he conceals the factum of his hospitalisation for a particular disease or having undergone operation for the disease in the near past."
Awarding a compensation of Rs 2 lakh to Sri Chand Jain, the commission said it had come across cases where consumer claims were denied for not having disclosed even minor physical problems that the insured had been facing for decades without it affecting day-to-day life or ever necessitating hospitalisation.
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