Panel: 2-year waiting period of medical policy unjust

Dismissing the revision petition by Oriental Insurance Company Ltd, the Punjab State Consumer Disputes Redressal Commission has ordered the company to pay Rs 85,417 with 9 per cent interest to Niti Narang, a resident of Ludhiana, while upholding her medical claim.

Commission President Justice Daya Chaudhary and members Simarjot Kaur and Vishav Kant Garg allowed the complaint, partially, with the interest from the date of filing the medical claim (April 3, 2019) till its realisation. The insurance company has also been ordered to pay Rs 10,000 as compensation for mental harassment and Rs 5,000 more as litigation costs.

The Ludhiana District Commission has been asked to ensure the compliance after settling expenses already paid amount by the insurance company. Narang was admitted in Daya Nand Medical college and Hospital, Ludhiana, on March 7, 2019. She was diagnosed with chronic calcific pancreatitis following which she was operated. Afterwards, her bill of Rs 85,417 was submitted to the insurance company to claim the compensation. The company denied the claim citing “the exclusion clause of the insurance policy which provided for a waiting period of two years for any reimbursement”.

The state commission said “the District Commission had rightly observed that condition imposed of waiting period of 24 months in a yearly policy was unjustified and unsustainable”. The order also pointed out that “the terms and conditions of the policy were not provided to the complainant”.