VIRUDHUNAGAR: The District Consumer Disputes Redressal Commission in Srivilliputhur directed a health insurance company to settle an amount of Rs 1.95 lakh to a Rajapalayam resident and a fine of Rs 60,000 citing deficiency in service. The verdict was issued by president SJ Chakkkaravarthy and member M Muthulakshmi in a petition filed by P Sakthi Saravanan against the branch manager and general manager of the company.
In June 2021, the petitioner undertook a family health insurance policy of Rs 7,00,000 and renewed it, making it valid till June 2023. Meanwhile, he was diagnosed with avascular necrosis and surgeries done in June and July 2023, cost Rs 1,95,706 and Rs 1,95,301 respectively. When the respondents were approached seeking the insurance amount, they rejected the petition saying the pre-existing disease was not informed when the policy was undertaken.
The panel noted there was not enough evidence to prove the petitioner was suffering from the disease when he undertook the first premium of the policy. The panel observed a deficiency in service by the respondents and directed them to pay the insured amount of the first surgery Rs 1,95,706, and fined Rs 50,000 for causing mental agony and material loss, and Rs 10,000 for litigation.