Insurance company to pay Rs 7.3 lakh for refusal to reimburse surgery cost

The matter dates back to 2007 when S Shankar’s father K S Sundaram, a chronic diabetic, underwent by-pass surgery.

Published: 29th October 2018 08:24 AM  |   Last Updated: 29th October 2018 08:24 AM   |  A+A-


Image for representational purpose only.

By Express News Service

CHENNAI: A State-owned insurance company has been ordered by the State Consumer Disputes Redressal Commission, Chennai, to reimburse Rs 3.28 lakh to a city resident towards surgery cost. Earlier, the company refused to reimburse the claim even though it was covered under medical insurance.

Also, the company has been ordered to pay a compensation of Rs 1.2 lakh along with Rs 2.9 lakh as annual interest for delay in payment since 2008.

The complainant of Alwarpet appealed to the State Commission after his petition seeking compensation was dismissed by South Chennai District Consumer Disputes Redressal Forum as details of his father’s diabetic condition were not included in the proposal form while obtaining the insurance policy.

The matter dates back to 2007 when S Shankar’s father K S Sundaram, a chronic diabetic, underwent by-pass surgery. Though Shankar had been renewing medical insurance for his father, wife and son for Rs 5 lakh each since 2003, the cost of the surgery, which amounted to `3.28 lakh, was not reimbursed by National Insurance Company. The reason for this refusal cited by the company was that the disease for which Sundaram underwent a surgery was excluded from their insurance coverage.

“The complainant’s father was a diabetic for 15 years had suffered a heart attack two years ago and hence he was advised to undergo a by-pass surgery. Diabetes is an influencing factor for heart attacks. As any disease that may be caused by diabetes is not covered by insurance, we did not reimburse the cost,” said the insurer. But State commission dismissed this claim of insurance company as only diabetes was excluded from insurance coverage and not coronary artery disease, a common heart disease that Sundaram was suffering from.


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