Surat: “When a Class 10 student appears for his board exams during a serious illness, you should appreciate his courage and give him the best service in a critical condition.”Making these observations, the Surat Consumer Disputes Redressal Commission (CDRC) flayed an insurance firm and ordered it to pay a Rs 2.02 lakh claim to the family of the student who appeared for his Class 10 exams while undergoing treatment for perforated appendicitis at a hospital.However, The New India Assurance Co Ltd rejected the claim on the grounds that if the boy was taking the exam meant he did not require hospitalization.According to details of the case, the boy’s father, a trader in Udhna, had taken a mediclaim policy from with a Rs 5 lakh sum insured starting Jan 24, 2020. During the policy period, his son’s health deteriorated on March 11, and he was hospitalised. His condition was diagnosed as perforated appendicitis, and surgery was performed the same day. The boy had already enrolled for the board exams, which fell during his hospitalisation period until March 19.As the exams were important to him and to avoid losing an academic year, the doctor gave him special permission to appear for them with precautions.After his discharge on March 19, his father filed a claim of Rs 2.02 lakh, which the insurance firm rejected on May 22. Following this, the boy and his father approached the Surat CDRC on January 13, 2021, seeking the claim amount along with compensation and other expenses.During the hearing, the rejection letter was produced, which stated that, as per one policy condition, the complainant had appeared for exams during treatment. This, according to the company, meant that he did not require hospitalisation for the treatment.However, the boy’s advocate opposed this reason for rejection and argued that the doctor had granted permission only as a special case so that the student’s academic year would not be wasted. The boy’s illness was serious, but permission was given purely to safeguard his education.After hearing both sides, the court observed: “Looking at these specific circumstances and the case of a Class 10 board exam student, the firm should try to give him the best service in such a critical time. The firm should appreciate the boy’s courage to appear for the exam in a serious condition and pass the claim. In these circumstances, the act of rejecting the claim does not appear logical or judicious.”The court ordered the firm to pay Rs 2.02 lakh with 8% interest from the date the claim was filed. It also directed the company to pay Rs 12,000 for mental and physical harassment, along with Rs 8,000 towards litigation expenses.
