The insurance company refused to pay the amount spent on treatment, now it will have to pay a compensation of about 76 thousand

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Highlights

District Consumer Commission gave its decision. A 30 year old youth had consumed phenol by mistake. He is suffering from kidney disease.

Navdunia Representative, Bhopal. Often people take health insurance so that they can get help during treatment. In one such case, the consumer did not get the insurance amount despite the treatment being done during the insurance period. A consumer accidentally drank phenyl and was admitted to the hospital for treatment. The insurance company refused to pay the amount spent on the treatment.

The matter reached the District Consumer Commission. The bench of Commission Chairman Yogesh Dutt Shukla and member Dr. Pratibha Pandey held the insurance company guilty and ordered to pay the amount spent on treatment as well as mental compensation.

In fact, Mrinal David Thomas, a resident of Meenal Residency, filed a petition against United India Insurance Company in the District Consumer Commission in 2021. In this, he complained that he had taken insurance from 1 September 2015 to 31 August 2016. On April 30, 2016, due to power cut between 6 and 7 pm, he drank phenyl instead of medicine in the dark.

After that he was immediately admitted to National Hospital and his treatment cost Rs 68,800, but the insurance company rejected the insurance amount saying that the consumer had intentionally consumed phenyl. Three years later, the commission rejected this argument and held the insurance company guilty of deficiency in service and imposed a fine of Rs 76,800 on it.

Insurance company’s argument- he had consumed phenyl intentionally

The insurance company argued that it was the consumer’s fault that he had intentionally consumed phenyl to harm himself. Also, the insurance was cancelled on the basis of internal injury and drugs and alcohol. The consumer’s lawyer argued that he was a 30-year-old youth and was suffering from kidney disease. Due to this, he had mistakenly consumed phenyl instead of medicine. The commission rejected the argument of the insurance company.

They say that

The consumer had kidney problems. Due to this he was already taking medicines. That day there was a power cut so the consumer accidentally drank phenyl instead of medicine in the dark. In this case the insurance company could not prove its argument. Hence the compensation amount will have to be paid along with the insurance amount.

Hardik Srivastava, Consumer Advocate