Noida: The district consumer disputes redressal commission on Tuesday ordered Reliance General Insurance Health Care to pay a Surajpur resident Rs 46,210 towards a mediclaim claim it had rejected, along with 6% annual interest from the date of filing of the case. The commission ruled that the claim was denied on false grounds.The panel, comprising president Anil Kumar Pundir and member Anju Sharma, noted that the policyholder had disclosed all pre-existing medical conditions while purchasing the plan and directed the insurer to settle the claim within a month. The company was also directed to pay Rs 2,000 as litigation cost and Rs 2,000 as compensation for causing mental agony to policyholder Rajkumar Bhati.Bhati had filed an application with the commission on Jan 30, 2024, saying he had obtained a group mediclaim policy from Reliance General Insurance Health Care in 2019, which covered treatment cost up to Rs 2 lakh. He renewed the policy in subsequent years by paying the premiums on time.When Bhati fell ill on Oct 11, 2023, he contacted the company, and the customer care officer said he could seek treatment at any nearby hospital, other than the company’s healthcare provider. Bhati got admitted to Nishkarsh Medicare Centre located at Zeta 1, Greater Noida, and was discharged on Oct 15. He said he had spent Rs 46,210 on his treatment and sent all the bills via email to the insurer. His claim was rejected.He then sent a notice to the insurer through his lawyer on Dec 24, but no response was received. Describing the actions of the company as deficiency in service under the Consumer Protection Act, Bhati sought relief from the commission.The company, in its response, denied any deficiency in service and claimed the policyholder had not disclosed pre-existing ailments while purchasing the policy. “The complainant has made false allegations,” the counsel appearing for the insurance company said.The commission, however, noted that Bhati had submitted supporting documents, including affidavits. It observed that the records showed he had disclosed his medical conditions at the time of purchasing the policy and mentioned them in the policy documents.Observing that the insurer failed to provide evidence to support its claim of non-disclosure, the commission ruled in favour of the complainant and directed the company to settle the claim within 30 days.
