Governance: Insurance companies pulled up over mediclaim

With medical costs increasing nowadays to a large degree and with specialized treatment becoming much more expensive, having medical insurance is absolutely necessary. Not having medical insurance means that you can be in a tremendous financial problem when the need arises to avail of medical services. However, it gets problematic when the insurance company uses any means to avoid paying the insurance claim. In such cases, it is the consumer redressal forums that intervene and get the insurance company to pay the claims:

NEW DELHI: The State Consumer Commission has rebuked three public insurance companies for wrongly repudiating the ‘mediclaim policy’ and insurance claims against ‘life-policy’ in four different cases on grounds of concealment of pre-existing ailments. The companies – namely Life Insurance Corporation of India, Oriental Insurance Company and New India Assurance Company – were pulled up by the city’s apex consumer commission for rejecting, ‘on highly flimsy grounds’, legitimate claims made by consumers.
The insurance companies have been directed to pay lakhs in compensation for the wrongful rejection of the claims made under various policies.
Justice Kapoor clearly noted that “Malaise of hypertension,diabetes, occasional pain, cold, headache, arthritis and the likes in the body are the wear and tear of modern day life which is full of tension at the work place … These cannot be used as concealment of pre-existing disease for repudiation of an insurance claim, unless an insured in the near proximity of taking of the policy is hospitalised or operated upon for treatment of these diseases or any other disease.’’

This judgment will be useful for all mediclaim users, given that at the times of emergency when there is a need for money, there should not be the fear that the claim will be rejected for some reason or the other.