The District Consumer Disputes Redressal Forum-III, Hyderabad, on July 13 directed the Life Insurance Corporation of India (LIC) to pay a complainant Rs.1.5 lakh as compensation for refuting her claim, thereby resulting in deficiency of service.
The ruling was based on a petition by one Saraswathi K., a resident of Qutubullapur. She approached the District Forum on May 15, 2015, claiming that in spite of having a valid policy which was functional since 2009, the LIC had repudiated a medical claim of Rs.2.33 lakh she had submitted in September 2014.
Ms. Saraswathi was admitted in a city hospital after she had suffered a heart attack in August 2014.
In her complaint, Ms. Saraswathi said that she had taken an LIC Health Plus Plan in 2008, for which she had to pay a premium of Rs. 9,000 per annum. Having missed paying the premium in 2009, the complainant had requested the LIC to renew the policy, for which she was asked to pay an additional sum of Rs. 5,000 every year and undergo a medical test. Hence she was shelling out Rs. 14,000 a year as premium.
Ms. Saraswathi said that after repeatedly asking for reasons for the rejection of her claim, she was offered a settlement of Rs. 2,600, which was paid to her on March 31, 2015. In its response, the LIC stated that the policy in question was taken under the name of K. Ramalakshmi Reddy, under which the complainant was an insured member.
The LIC told the Forum that Ms. Saraswathi’s claim was referred to a third-party agent and rejected on the grounds that she had a pre-existing illness and that surgery was not listed in the allowed surgeries.
On scrutinizing all the evidence at hand, the Forum termed LIC’s rejection of the claim as ‘unjust and improper’. Stating that the actions amounted to deficiency of service, the Forum directed the LIC to pay the complainant Rs.1.5 lakh as compensation within 30 days of the order.
