Punjab: 2 year waiting period for medical policy is unfair

Punjab: Dismissing the revision petition of Oriental Insurance Company Limited, the Punjab State Consumer Disputes Redressal Commission has ordered the company to pay Rs 85,417 with 9 per cent interest to Neeti Narang, a Ludhiana resident. Commission chairperson Justice Daya Chaudhary and members Simarjot Kaur and Vishvakant Garg partly accepted the complaint with interest from the date of filing of the medical claim (April 3, 2019) till its recovery. The insurance company has also been ordered to pay Rs 10,000 as compensation for mental harassment and Rs 5,000 as litigation costs.
The Ludhiana district commission has been asked to ensure compliance after settling the amount already paid by the insurance company. Narang was admitted to Daya Nand Medical College and Hospital in Ludhiana on March 7, 2019. He was diagnosed with chronic calcific pancreatitis following which he underwent surgery. Subsequently, a bill of Rs 85,417 was submitted to the insurance company to get compensation. The company rejected the claim citing “exclusion clause of the insurance policy which provided for a two-year waiting period for any reimbursement”. The state commission said that “the district commission was right in holding that the condition of a 24-month waiting period in the annual policy was unreasonable and unreasonable”. The order also pointed out that “the terms of the policy were not provided to the complainant”.