Heart Patient Wins Case Against Insurer

Consumer forum tells firm to pay up full amount she was eligible for

Published: 10th October 2014 06:18 AM  |   Last Updated: 10th October 2014 06:18 AM   |  A+A-

BANGALORE : A consumer forum has directed an insurance company to reimburse the full amount claimed by a senior citizen towards a heart procedure.

The Additional Bangalore Urban District Consumer Disputes Redressal Forum has held Star Health and Allied Insurance Company guilty of deficiency of service for refusing to reimburse the full amount promised under its policy.

Violet Rajan (65) was insured for `2 lakh. In March 2013, she developed breathlessness and got an angiogram done.

She was advised implant of a pacemaker to regulate her heart rate. The device was implanted on March 18 that year.

She spent a total of `2.83 lakh for the procedure and claimed `1.5 lakh, the maximum amount offered under the policy for heart disease. However, Star released only `71,000.Violet Rajan said the company was liable to pay her an additional `79,000.

She filed a complaint with the consumer forum on July 23, 2013.

The insurance company did not dispute its liability. However, it said the amount payable was `1.05 lakh, and offered to settle the balance since it had already paid `71,000.

The forum went through the arguments and held that the complainant had to pay only 30 per cent of the total amount and the insurance company was liable to pay the rest, subject to a maximum of `1.5 lakh.

It upheld Violet Rajan’s entitlement to claim the full `1.5 lakh.

The forum has ordered Star to pay `79,000 with annual interest at 10 per cent. The company has also been directed to pay her `5,000 towards costs.

Advocate G R Mohan says the ruling, though of interest to the public, cannot be cited as a precedent. “Each case is decided on its circumstances,” he told Express.

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