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Health Insurance Claim Procedures
(1) Health Insurance Claim Procedure   (2) Protect Your Interest
(3) Claim Form to be Sent to TPA   (4) Circumstances under which claims get Rejected
(5) Claims not Allowed - Some Case Studies   (6) Consumer Forum Cases in Health Insurance (Some Judgments)
6- Consumer Forum Cases in Health Insurance (Some Judgments)
6-Insurance co challenged only quantum of relief
The Supreme Court in August 2011 rejected National Insurance Company’s appeal against the high court order that awarded compensation to a woman who lost her unborn child in an accident with a state transport bus.
The bench at the time of entertaining the appeal had found the question can a fetus be considered a child for the purpose of compensation. It realized that the insurance company had not questioned the correctness of the award made by the tribunal, determining the amount of compensation towards the loss of unborn child. It had only challenged the quantum.
The appellant company is now stopped from contending that an unborn child cannot be considered to be a child for the purpose of claiming compensation under Section 166 of the MV Act. Justice Jain, writing the judgment said. It is manifest from the judgment under challenge that the question for consideration before the HC in the claimant’s appeal was with regard to the quantum of compensation and not entitlement of claim for grievous injury to a 30-week-old child in uterus resulting in the birth of a stillborn child, the SC said, upholding award of Rs.1.80 Lakh to the woman.
7-The Hindustan Times Chandigarh dt 31st march'2010 .carried the details of the case;
Mr. Ahuja is having Health Insurance from Royal Sundaram. He was diagnosed with CAD angina, for which he had to undergo Coronary Angiography and Angioplasty, which was informed to company with proper procedure. But company rejected the claim on the ground that complainant was known case of Hypertension since 2000. On explanation by the customer company replied that the complainant concealed the fact that he suffered from Heart disease along with Hypertension since the year 2000, which is specifically excluded under policy terms.
Consumer Forum judgment: It cannot be said if the complainant was suffering from Hypertension nor can it be said that he concealed the disease at the time of purchasing the policy.” Needless to mention that CAD is totally different disease than hypertension. The claim for CAD therefore cannot be repudiated on the ground that the complainant was suffering from Hypertension.
We appreciate this judgment as it has been customary for the insurance companies to reject the claim on the basis by taking the lea of hypertension.
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