THIRUVANANTHAPURAM: The Kerala State Consumer Disputes Redressal Commission (KSCDRC) has directed a medical insurance firm to pay the reimbursement it had withheld to a senior citizen after attracting her through a special senior citizens scheme.
As per the complaint filed by Azeez, son of Khader of Kuttikaitha, Ambalavayal, Wayanad, he had taken out a policy worth Rs 3 lakh from Star Health and Allied Insurance Company for his mother in March 2012. The special Senior Citizens’ Red Carpet Insurance Policy did not require a medical checkup. In September 2012, the woman fell ill and was referred to the Medical College Hospital, Calicut which suggested a heart surgery. Finally the surgery was done at Moulana Hospital, Perinthalmanna in March 2013.
But cashless benefit was denied by the insurance firm and Mr Azeez had to pay a bill amount of '2.18 lakh. The insurance firm rejected the claim, saying that the woman had fallen ill within a month of taking the policy. As a result, Azeez moved the consumer disputes redressal forum demanding the money with compensation.
The insurance firm contended that the woman was having hypertension from 2009, hyperlipidemia since 2011 and knee issues since 2010. The health history column of the proposal form did not disclose any of the diseases. The respondent argued that though his mother had other diseases she had not undergone any treatment for heart disease.
Wayanad Consumer Disputes Redressal Commission ordered in favour of the patient. When the insurance firm went for an appeal to KSCDRC, it observed that the type of advertisement given to the senior citizen scheme amounts to unfair trade practice by giving false information to attract persons. Hence, the Commission ordered that the expense incurred for the treatment should be paid apart from a compensation of Rs 1,000.
