Insurance co to compensate woman for rejected claim

Jun 24, 2012, 09:20 IST | Samarth Moray

District Consumer Disputes Redressal Forum orders National Insurance Co Ltd to reimburse woman after refusing to pay for incisional hernia

The District Consumer Disputes Redressal Forum at Parel has ordered the National Insurance Co Ltd to compensate a Bhayandar-based woman for wrongly rejecting her insurance claim.

The complainant, Jayantilal Prajapati, had obtained a Hospitalisation and Domiciliary Hospitalisation Benefit Policy for his family. While the policy was in force, his wife Manju suffered an incisional hernia and was hospitalised at Ravi Surgical Nursing Home in Bhayandar (W) in 2006 that ran up a bill of
Rs 15,597. Incisional hernia is a complication that develops as a hernia within the scar of a previous operation.

The insurance company rejected her claim on the grounds that her condition was the result of a tubectomy conducted a year and a half before she developed hernia.

On February 19, 2007, she received another letter from the firm giving a different reason for rejecting her claim.

A bench comprising President SB Dhumal and member SS Patil concluded, “Though tubectomy is an operation for sterility, the patient was not hospitalised for it. Incisional hernia is

The court directed the company to reimburse the amount along with 9 per cent interest from November 30, 2006. An additional Rs 5,000 was awarded for the mental agony endured by the complainant, with Rs 3,000 more as costs. 

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