The LIC of India has been directed to pay a sum of Rs. 1.5 lakhs to a policy holder who approached the District Consumer Disputes Redressal Forum III here, saying that the insurance company had rejected a valid medical claim she had made.
Saraswathi K said she had a valid LIC Health Plus Plan, and had submitted a claim amounting to Rs. 2.33 lakh which she had spent for treatment following a heart attack.

She said she had been paying a premium of Rs. 9000 per annum for the policy till 2009, when she had missed an installment of the payment, but she had requested LIC to renew the policy, and had been paying the requisite sum of Rs. 5,000 each year, thus paying a total of Rs. 14,000. She had also underwent the mandatory medical test, Saraswathi said.

However, her claim for the amount she spent on treatment was met with a sanction of only Rs. 2,600. When she asked for the reason, the insurance company said the policy had been taken in the name of K. Ramalakshmi Reddy, under which the complainant was an insured member.

However, LIC told the Forum that Ms. Saraswathi’s claim was rejected on the grounds that she had a pre-existing illness and that cardiac surgery was not listed in the allowed surgeries.

The Forum went through all the evidence, and found LIC’s rejection of the claim ‘unjust and improper’ and ordered the company to compensate Saraswathi.

Source: http://www.thehindu.com


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