Oriental Insurance Asked To Pay 10,900 Euros Cost for Medical Treatment in Paris
Moneylife Digital Team 03 April 2024
While partly allowing an appeal, the national consumer disputes redressal commission (NCDRC) directed Oriental Insurance Company Ltd to pay the 10,899.51 euros cost incurred for medical treatment in Paris. NCDRC also set aside an order by the Punjab state consumer disputes redressal commission to pay the entire insurance claim of US$50,000.
 
In an order last month, the NCDRC bench of Subhash Chandra (presiding member) and Dr Sadhna Shanker (member) says, "The fact that the insured was suffering from hypertension cannot be held against the insured since hypertension itself is not a life-threatening disease and has been widely recognised as a lifestyle disease. It has not been disputed that expenditure of 10,899.51 euros was the cost incurred by the complainant, which is within the insurance cover of US$50,000."
 
Harnek Singh from Nalina Kalan village in Fatehgarh Sahib district bought an overseas mediclaim insurance policy for US$50,000 from Oriental Insurance Company to cover any sudden or unforeseen illness while on travel abroad. However, while travelling overseas, he suffered a precocious myocardial infarction complicated by acute pulmonary edema and died in a hospital in Paris.
 
When the insurance claim was rejected, his son Jagtar Singh approached the state commission. While allowing the complaint, the Punjab state commission directed Oriental Insurance Company to pay US$50,000, the insurance amount, along with Rs50,000 in compensation for harassment and agony and Rs10,000 as litigation expenses.
 
The state commission also dismissed a review petition filed by Oriental Insurance Company. It then filed a first appeal before NCDRC. The bench of Mr Chandra and Dr Shanker observed that Harnek Singh suffered a precocious myocardial infarction complicated by acute pulmonary edema while in transit in Paris.  
 
According to the insurer, complications from hypertension were one of the proximate causes of myocardial infarction and, therefore, it contended that the state commission erred in allowing the complaint.
 
The counsel for Jagtar Singh contended that an overseas mediclaim insurance policy for US$50,000 was obtained to cover any sudden or unforeseen illness while on travel abroad and the cause of death, precocious myocardial infarction, which means a 'pre-mature heart attack' with swelling of lungs with water, constitutes a sudden and unforeseen illness. 
 
"As per the death certificate of Harnek Singh dated 23 December 2010 issued by the treating hospital, the death was on account of a sudden medical condition and not a pre-existing illness and therefore, the complainant was entitled to the insurance amount as assured," the counsel added.
 
NCDRC noted that the state commission referred to a judgement by the Supreme Court in the Biman Krishna Bose vs United India Insurance Co case, in which the apex court held that an insurance claim cannot be repudiated if the insured was suffering from hypertension since hypertension is not a material disease which is fatal in itself.
 
"The order of the state commission is a reasoned and detailed order which sets out clearly that hypertension per se is not a fatal disease and that the insured in the instant case had suffered a sudden heart attack as per the report of the treating hospital in Paris. We, therefore, find no reason to interfere with this order since the objective of the policy was to cover any such sudden incident relating to the health of the insured," NCDRC says.
 
Modifying the state commission order, NCDRC directed Oriental Insurance Company to pay within six weeks 10,899.51 euros with costs with an interest of 9%pa (per annum) from the date of rejection of the claim and Rs50,000 as litigation cost to Jagtar Singh. 
 
(First Appeal No61 of 2014 Date: 18 March 2024)
Comments
mohdirfan509
1 month ago
It's a waste insurance company
They cutting so many medical expenses of needy people
Company only get richer
Don't go with this insurance company guys
pereseugene
1 month ago
Thank you Money Life....always the first to walk the extra mile to highlight these cases where Service Providers like OICL default on their core deliverables to their customers. ...would like to affirm and congratulate Jagtar Singh for pursuing with perseverance to be finally vindicated.
one of my senior citizen friends is in the same boat wherein an appeal letter dent to the attention of CMD R.R. Singh over a year ago has not been responded...either it has fallen between tables or the appeal pushed under the carpet. Courtesy warrants a reply from CMD R.R. Singh desk. Furthermore, IRDA, should ensure full transparency and disclosure of senior management, grievance nodal officer, contact names and nos of all Insurance service providers be correctly updated on the companies homepage/website for urgent grievance redressal and satisfactory resolution and closure. I will be only willing to share my friends grievance...he is 83 years old and is out of pocket coughing up huge medical bills, which is not yet honoured till date despite MDI the TPA furnishing all details ansd relevant enclosures.....will some compassionate soul from OICL take immediate cognisance and make the reimbursement before my friend takes recourse to FB and other platforms of social media.
Smart One
1 month ago
It's a genuine case. Insurance companies are very much kind. They take money from all but give back to a few needy fellows. Thanks Oriental uncles, Good God bless you and your junior staff as well. RIP Singh uncle.
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