The National Consumer Disputes Redressal Commission (NCDRC) has directed the Oriental Insurance Company Limited to pay the insurance claims of USD 2,40,000, which Mukul had spent for his treatment as an in-house patient in Colorado in May 2010 during his trip to the USA, along with interest at the rate of 9% per annum from December 2010, according to the Hindustan Times.
Soon after the insurance company repudiated his claim on December 30 in 2010 on the grounds that the cause of his hospitalization (Malaria) in Colorado was a pre-existing illness, Sonowala immediately moved to the NCDRC and questioned the repudiation of his claim.
He said that he had obtained overseas travel insurance by paying the premium and it provided the cover of USD 2,50,000. Mukul also said that he would not have travelled overseas if he was unwell and pointed out that he had been examined by an authorized doctor of the said insurance company before issuance of the insurance. The doctor did not diagnose any pre-existing illness at that time, he told HT.
Further, he alleged that the act of repudiation was an illegal and unfair trade practice, seeking direction from the insurance company to pay the claim with interest at the rate of 18 compensation for mental agony and the cost of the litigation.
The insurance company contested the consumer complaint and claimed that according to the reports, there had been an outbreak of malaria in Mumbai and prior to his departure, his son and a few neighbours had also contracted malaria, as per HT reports.
In addition to this, the insurance company had also submitted an opinion from a doctor on the same. According to the doctor, the P-Vivax malaria incubation period varies from 10 days to 2-4 years, the insured was in the carrier stage when he travelled to the USA and claimed that as per the Mediclaim Policy conditions no pre-existing conditions are payable and therefore the claim was repudiated under the exclusion clause.
However, these submissions failed to convince the NCDRC. A single-member bench of presiding member Subhash Chandra said, "As on the date of the medical examination by the authorized doctor of the opposite party (insurance company) the complainant was not found to be suffering from malaria."
The commission said there is no evidence produced by the insurance company to establish the fact that malaria was a pre-existing illness, rather it is only a presumption and assumption that he had contracted the viral disease from his son or neighbors, according to HT.
Therefore, the NCDRC directed the insurance company to pay the Marine Drive resident the claim amount of USD 2,39,991.81 along with interest at 9% per annum from December 30, 2010, when the claim was repudiated. It also stated that if the company fails to pay the amount in two months, it will have to shell out interest at the rate of 12% per annum.
