The Consumer Disputes Redressal Forum, Ahmedabad City, has ordered United India Insurance Company to pay Rs 2,07,149, with 10 per cent interest from 18 February 1999 till the date of payment, to Kashiben R. Patel, Ahmedabad, in settlement of her complaint on mediclaim.
Consumer Education and Research Society (CERS), Ahmedabad, and Kashiben had filed a complaint in the Forum against United India Insurance Company. Kashiben and her husband had taken a joint medical insurance policy in 1993. From 1993 to 1998 they had paid the premium, renewed the policy regularly and had not made any claim.
On 18 January 1999, the insured was operated at the Shelby Orthopedic Hospital in Ahmedabad and she produced bills of all her expenses and claimed Rs 2,07,109 from United India.
But the company repudiated her claim, saying the disease had been pre-existing during the renewal of the policy and that Kashiben and her husband had raised the insurance cover from Rs 70,000 to 2,00,000 with mala fide intentions.
While taking the policy in 1993, the highest amount available as the insured sum was Rs 70,000. In 1998, the insurance company itself raised the maximum cover to Rs 2 lakh. The couple opted for the Rs 2 lakh cover.
On 4 May 2004, the Forum ordered United India Insurance Company to pay Rs 2,07,149 with 10 per cent interest to Kashiben. A compensation of Rs 5000 towards mental harassment and a cost of Rs 2000 were also awarded to the complainant.