President of the forum Umesh Jhavalalikar and member N D Kadam, in their order issued recently, also asked the insurer Reliance General Insurance Company to pay Rs 3 lakh towards the medical claim of the complainant.
In his complaint to the forum, Arvind Chhaganlal Jain of Bhayander said that he had taken a medical insurance cover of Rs 3 lakh from Reliance in March 2009.
However, soon after he suffered a cardiac problem and had to undergo a bypass surgery and sought the insurance amount from the company.
However, Reliance outrightly rejected the entire claim alleging that the claimant had concealed his ailments while taking the insurance cover from it and therefore his claim was wrong.
Following this, the claimant approached the forum and demanded Rs 3.69 lakh with 18 per cent interest and Rs 50,000 towards compensation and Rs 15,000 legal expenses. The company told the forum that it had carried out an investigation through a private agency, which stated in its report that the claimant had cheated by hiding his illness.
But the forum referred to the National Consumer Disputes Redressal Commission ruling which stated that the insurance company has to give sufficient proof and submit the documents to prove its stand for rejecting its claim, which the insurer did not do.
Since the company did not place before the forum the report of the investigation carried, the forum concluded that the insurance company was deficient in its services and should settle the claim and also pay compensation.
Both, the insurance company and the claim settler Medi Assist are liable to pay the compensation, the forum ruled in its order.
It ordered to the insurer to make payment of Rs 3 lakh to the complainant, besides Rs one lakh compensation.