Upholding an order of the Amritsar Consumer Disputes Redressal Commission, the Punjab State Consumer Disputes Rerdressal Commission (Chandigarh) has ordered the Star Health and Allied Insurance Company to pay Rs 2.13 lakh to Amritsar resident Kuldeep Singh who had been denied his claims despite not having been provided the exact terms and conditions of the policy he purchased.
President Justice Daya Chaudhary and member, Simarjot Kaur, directed the company to pay the claim with seven per cent from the date of filing the complaint till its actual payment. The company has also been ordered to pay Rs 40,000 as compensation and Rs 5000 as litigation expenses within 45 days of receipt of the order.
Kuldeep Singh had a cashless mediclaim policy for the period from September 17, 2020 till September 2021. He was admitted in a local hospital in July 2021 for treatment of acute pancreatitis for which he requested for cashless treatment.
The company argued that the patient had an old history of the pancreatitis and disease and “as per the terms and conditions of the policy, the claim for the disease relating to acute pancreatitis was not payable for a period of two years from the date of inception of his policy”.
The state commission upheld the order of the district commission which pointed out that that the insurance company could not produce any proof that the complainant had concealed any fact related to his ailment or hospitalisation. It also clearly said that “in case the terms and conditions, including the Exclusion Clause, were not supplied to the insured, the same cannot be enforced upon”.
