Kerala: Private insurer asked to refund health insurance

THIRUVANANTHAPURAM: The Thiruvananthapuram Consumer Disputes Redressal Forum has directed a private insurer to refund Rs 2.04  lakh health insurance and pay Rs 25,000 compensation to the family of a deceased man who was denied payment  for allegedly not declaring his diabetes mellitus and cardiac conditions while availing of the policy. The complainant, Khuraisha Beevi of Pothencode, was the holder of Apollo Munich Health Insurance policy.

It covered her husband E. Abdul Hameed.  Hameed, who fell down from the terrace of his house,  sustained serious injuries on his left leg and his bone was seen projecting out.  He was admitted to the Medical College Hospital here on March 28, 2011 and was there until August 2, 2011.  Later, he died.  He incurred various expenses,  including  medical,  room rent, bystander and miscellaneous amounting to over Rs 2.04 lakh. The company disallowed his wife’s claim saying that he was suffering from diabetes for the past five years. Lack of intimation of hospitalisation and delayed submission of document were also cited as reasons for denying the insurance payment.

As per regulations,  the insurer should have been informed within seven days of hospitalisation. Beevi moved the consumer forum and pointed out that the policy covered not just sickness but also accidental benefits. She contested that the rejection of the claim was not based on facts.  The company could produce only unverified case sheet and this was not accepted as a reliable piece of evidence by the forum. Advocate Cherunniyoor P. Sasidharan Nair appeared on behalf of the complainant.