Hyderabad: A gutsy home-maker from Warangal fought a long battle, including filing an RTI appeal, to procure evidence against SBI General Insurance Co Limited which had refused to pay the policy amount in a case of accidental death.
Ms Kusuma Sunitha then took the data to the consumer forum, where she secured an order in her favour. Ms Sunitha said that her brother Shyam Prasad had died in a motorcycle accident on July 4, 2014.
He was working as a screen printer at Warangal and had purchased a Rs 2 lakh personal accident policy from SBI General Insurance on August 12, after paying the premium.
The accident occurred when Prasad swerved his bike to avoid a pedestrian. The bike skid, Prasad fell down and sustained a head injury. He was taken to MGM Hospital by onlookers and then to Rohini Super Speciality Hospital, Hanamkonda. From there, he was shifted to Gandhi Hospital where he passed away while undergoing treatment.
Ms Sunitha submitted the claim form along with relevant documents to SBI General Insurance to settle the policy. The company repudiated the claim on the ground that she could not produce the treatment record at MGM Hospital.
She then filed an RTI query and secured the information from MGM Hospital. The records did not have Prasad’s name. Hospital officials stated that patients are generally given a slip and their names are not entered in records.
Despite filing all necessary documents from Gandhi Hospital, the insurance company refused to pay the policy amount. SBI General Insurance contended that it needed to see the records of MGM Hospital before it settled the claim.
The forum observed that SBI General Insurance did not deny that Prasad had death or that the premium had not been paid. It only raised a dispute with regard to the non-furnishing of medical record of MGM Hospital. The forum asked why the insurer did not inquire with MGM Hospital, and fail to consider treatment records of Gandhi Hospital.
