BENGALURU: This is one judgment that will positively impact senior citizens and their insurance. A consumer forum in the city has ordered an insurance company to reimburse the claim with interest, compensation and litigation cost to a 74-year-old woman whose claim for insurance to meet expenses for treating her old-age-related osteoarthritis was rejected by the company.
“Issuing a policy to a person of more than 74 years, after collecting premiums and then stating that ‘age-related diseases’ are excluded amounts to unfair trade practice,” the forum said.The Bangalore Urban District Consumer Disputes Redressal Forum, comprising president S L Patil and Member P K Shantha, ordered the Oriental Insurance Company Ltd (OICL) to reimburse the claim to Nirmala Govind Navivadekar, resident of Sun City, Iblur.
OICL has to reimburse the claim of Rs 1,15,000 with interest at the rate of 18 per cent per annum from September 7, 2018, the date of filing this complaint, till the date of realization and to pay an amount of Rs 10,000 towards mental agony, trauma and hardship suffered by the complainant. The forum has also ordered it to pay Rs 5,000 as litigation costs.
Based on the medical advice, as she was experiencing severe pain in both the knee joints which practically curtailed her day-to-day living due to osteoarthritis, Nirmala underwent Sequentially Programmed Magnetic Field (SPMF) therapy for 21 days consecutively at SBF Healthcare and Research Centre. The treatment enabled her to resume normal day-to-day activities.
Her medical expenses came to Rs 1,15,500. Much to her shock, OICL rejected the claim on the ground that this therapy was unproven claim as per policy terms and conditions.On hearing both the parties, the forum said: “When SPMF therapy is not specifically excluded, OICL’s act in repudiating the claim on the ground that the treatment is similar to RFQMRT (Rational Field Narrow Focuses Quantum Magnetic Resonance Treatment) without adducing any expert evidence to that effect or filing the affidavit of any doctor to prove the same, amounts to deficiency of service.”