Bajaj Allianz directed to pay 2.19 L to customer

Khairtabad: The Telangana State Consumer Disputes Redressal Commission has directed Bajaj Allianz General Insurance to pay Rs 2, 19,902 as medical expenses and Rs 10,000 towards compensation for mental agony and trauma of its customer, Govind. The insurer was granted 30 days to comply with the order.

Commission President Justice MSK Jaiswal in an order stated, "The company needs to verify the customers' health issues. It is the responsibility of the insurance company to investigate the realities of the customers' health. Hence, the contention that the customer will not be paid compensation does not hold."

In the judgment, Consumer Forum ordered the company to pay the amount spent by Govind. The complainant Govind Modi, who was 35 years old at the time of being insured, said that the insurance company told him that no medical test was required for people under 40 years old. The sum assured was Rs 5 lakh, and he paid a premium of Rs 6,916, which covered for the period from June 2012 to June 2013.  

In November 2012, he was admitted in a private hospital and was treated for hypothyroid, of which he had no knowledge of. In January 2013, he was admitted in another hospital and was diagnosed with prolapsed intervertebral disc.

The insurance company did not give him permission to avail of the cashless treatment, for which he was billed Rs 2.19 lakh. The company then rejected his insurance claim. The company contended that the complainant was suffering from a 'pre-existing' ailment, which he 'suppressed' at the time of applying for the policy.

Taking the evidence placed on record, the commission stated that it cannot be said that the respondent insured was suffering with the neck problem resulting into surgery. It also pointed out that the while filling the details at the time of policy purchase, the complainant did not deny any pre-existing ailment, but mentioned 'not applicable.'