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Aggrieved Customer Sues Insurer, Wins Rs 1.58 Lakh in Health Insurance Claim

by Lakshmi Gopal on  September 19, 2011 at 8:46 PM Health Insurance News   - G J E 4
An aggrieved customer of Royal Sundaram Alliance Insurance Co Ltd., Ghatkopar resident, Mr Vallabh Shah, has won a health insurance claim worth Rs 1.58 lakh. The company had earlier rejected the claim, reports Mumbai Newsline. The case was contested by Shah at the Mumbai Suburban District Consumer Disputes Redressal Forum.
 Aggrieved Customer Sues Insurer, Wins Rs 1.58 Lakh in Health Insurance Claim
Aggrieved Customer Sues Insurer, Wins Rs 1.58 Lakh in Health Insurance Claim
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The forum decided in favor of the customer, who will now be paid the insurance amount of Rs 1.58 lakh along with 9 per cent interest from May 2008. The cost of complaint - Rs 10,000 will also be reimbursed by the insurer.

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It all began in the year 1988, when Shah underwent a blood transfusion during his treatment for ulcer and duodenal bleeding. He contracted Hepatitis C during the blood transfusion. For 18 years, he led a normal life and remained unaware of his condition. In 2006, he came down with Hepatitis C and was subsequently hospitalized for its treatment. His insurer turned down his health insurance claim saying that it was a pre-existing condition - not eligible for the claim.

Shah had to foot the entire medical bill amounting to Rs 1.58 lakh.

In his complaint, Shah said he had bought a health insurance policy from the company in 2003 for Rs 2.30 lakh. He moved a grievance petition before the Insurance Ombudsman, but it was rejected in December 2007. In May 2008, Shah filed the complaint in the district forum alleging deficient service.

Source: Medindia
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