Ahmedabad: A district consumer commission in Ahmedabad has directed United India Insurance Company Ltd to pay Rs 3 lakh, along with 7% annual interest, to a policyholder, ruling that the insurer’s rejection of his mediclaim for cancer treatment was arbitrary, illegal and invalid.The District Consumer Disputes Redressal Commission (Additional), Ahmedabad, passed the order on a complaint filed by the Consumer Education and Research Centre (CERC) and policyholder Upendra Thakkar.According to the complaint, Thakkar’s wife underwent treatment for bone marrow cancer between Oct and Nov 2018, incurring medical expenses of Rs 17.3 lakh. Thakkar sought reimbursement of Rs 3 lakh, the sum insured under his mediclaim policy. The insurer however, rejected the claim, citing policy exclusions relating to genetic disorders and stem-cell implantation or surgery.The commission, however, noted that the insurer did not appear during the final hearing and failed to place on record the policy terms and conditions or documentary evidence to justify rejecting the claim. It observed that the burden of proving the applicability of the exclusion clauses rested with the insurer.The commission also took note of the complainant’s submission that he had been renewing the policy since 2008. In the absence of supporting evidence from the insurer, it declined to accept the repudiation.The commission directed the insurer to pay the insured amount of Rs 3 lakh with 7% annual interest from Feb 4, 2020, the date of filing of the complaint, until payment. It also awarded Rs 2,000 as compensation for mental agony and physical harassment and Rs 2,000 towards litigation costs. The insurer has been directed to comply with the order within one month.
