According to Manoj Mhamunkar's complaint, he had opted for a mediclaim policy from the insurance firm, which was valid till 2013.
The Mumbai suburban district Additional Consumer Redressal Forum recently penalised the Star health insurance firm for wrongly repudiating the insurance cover of a Thane-based consumer. The forum directed the firm to pay the consumer the insurance cover amount of Rs 65,000, along with 10 per cent interest rate on the amount from the year 2014. The forum also directed the firm to pay an additional amount of Rs 40,000 towards the complainant's mental agony, along with Rs 5,000 towards ligation charges.
According to Manoj Mhamunkar's complaint, he had opted for a mediclaim policy from the insurance firm, which was valid till 2013. The cover amount for the policy was Rs two lakh, for which he had paid a premium amount of Rs 7,114. In 2013, the complainant's wife started suffering from cardiac issues and was advised immediate treatment. As the complainant's monetary condition was not sound, he decided to get his wife treated at the KEM hospital, instead of approaching private hospitals.
After the treatment was successful, the complainant informed the insurance firm about the expenses incurred. His application, however, was not accepted by the insurance firm. The complainant then approached the forum and filed a case. The forum, after going through the complainant's plea, asked the insurance firm to file its reply. The firm claimed that the complaint was false and frivolous. According to the firm, the complainant's wife was suffering from the heart ailment much before he purchased the policy, and that the firm was not intimated about that.
After going through the evidence produced, however, the forum held that there was no breach of contract from the consumer's end but that the firm wrongly repudiated the claim.
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