Insurance company told to pay 3 lakh compensation to pacemaker patient

MUMBAI: Reprimanding an insurance company for its hyper technical approach and adhering to a "pick and choose" theory, a district consumer commission has directed it to reimburse Rs 2.65 lakh along with a compensation of Rs 2.70 lakh to a 55-year-old Colaba woman who had undergone a pacemaker replacement surgery at a prominent South Mumbai hospital in 2019.

The company had rejected the claim on the ground that the discharge summary had mentioned that it was only a "pacemaker battery replacement." However, the commission clarified that the stray incorrect line was rectified with another discharge summary attested by the attending surgeon and also other documents also showed that it was a pacemaker replacement.

"Thus, very order of repudiation of claim being arbitrary based on wrong interpretation of the terms appears in discharge summary. Thus, order of repudiation found to be unsustainable under the law," the commission said.

Shauheen and Muneera Daya had moved the commission on August 28, 2019 against The United India Insurance Co Ltd and Genins India Insurance TPA Ltd. Shauheen submitted that he had purchased the policy for himself, his wife and daughter from September 1998. The policy was renewed from time to time.