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Bajaj Allianz General to pay Rs. 13.74 lakh for rejecting claim

According to the consumer forum, the insurer had arbitrarily denied their claim by taking the “excuse” of ‘pre-existing diseases’

September 10, 2012 4:45 IST | India Infoline News Service
The New Delhi District Consumer Disputes Redressal Forum has ordered Bajaj Allianz General Insurance to pay Rs. 13.74 lakh equal to $26,717.32 (amount spent on treatment in the US) to the husband and son of a late policy holder for rejecting her claim for reimbursement of expenses incurred on her treatment in the US.

According to the consumer forum, the insurer had arbitrarily denied their claim by taking the “excuse” of ‘pre-existing diseases’. The woman had undergone emergency treatment for abdominal pain in a hospital in the US in October 2008 with her son and had incurred expenses of $26,717.32. She had bought an overseas medical policy from Bajaj Allianz so submitted her claim for the expenses incurred, which the insurer rejected on the ground that her discharge summary mentioned pre-existing illnesses of diabetes and high blood pressure.

In its reply to the complaint made by the legal heirs of the policy holder (woman), Bajaj Allianz General had pleaded that had the pre-existing diseases been disclosed, it could have better assessed the risk. The forum, however, rejected the insurer’s contention saying “the discharge summary shows she was treated in emergency for abdomen pain etc... The discharge summary itself states that it had no relation with pre-existing diabetes... The conditions of overseas medical claim are not in conflict with the findings in discharge summary.

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