HYDERABAD: What if a health insurance firm refuses to cover benefits decreed under a cashless policy for not disclosing ‘common ailments’ like blood pressure and diabetes? Chances are that many would not want to fight out the matter owing to ‘terms and conditions’ of the insurance policy.
But, a consumer fought out his point at a consumer forum to have his Rs 2.5 lakh medical expenses covered under the insurance policy besides getting a compensation of Rs 35,000. The health insurance firm, Max Bupa Health Insurance, has been directed to pay the compensation. The complainant, M Rajeswar Srinivas (54), contested the insurance firm’s claim that he suppressed medical facts while availing a policy under its ‘heartbeat insurance policy’ in August 2014. In his complaint, Srinivas said he had asked the agents of the firm if he had to undergo medical tests but they said that it was not necessary. However, at the time of claiming policy, firm repudiated the claim saying that Srinivas suppressed medical facts by not disclosing that he had diabetes and hypertension.
Surprisingly, the medical reports from hospitals observed that Srinivas was a non-smoker, non-alcoholic and had no medical problem all through his life.The company argued that the matter was beyond the jurisdiction of the forum. However, the forum pointed out that it was reckless on the part of the agent not to conduct necessary tests before issuance of the policy.