Surat Consumer Court Orders Insurance Firm to Pay Rs 2.02 Lakh to Ailing Student
The Surat Consumer Disputes Redressal Commission (CDRC) has strongly criticized an insurance company for denying a medical claim to a Class 10 student who bravely appeared for his board exams while undergoing treatment for a serious illness. The court ordered The New India Assurance Co Ltd to pay Rs 2.02 lakh to the student's family, emphasizing the need for compassion in critical situations.
Background of the Case
In January 2020, a trader from Udhna, Surat, purchased a mediclaim policy with a sum insured of Rs 5 lakh from New India Assurance for his family. On March 11, 2020, his son's health deteriorated, leading to hospitalization. The boy was diagnosed with perforated appendicitis and underwent emergency surgery the same day.
Coincidentally, the boy had already enrolled for his Class 10 board exams, scheduled during his hospital stay from March 11 to March 19. To prevent him from losing an academic year, his doctor granted special permission for him to appear for the exams with necessary precautions, considering the importance of the tests.
Insurance Claim Rejection and Legal Battle
After the boy was discharged on March 19, his father filed a claim of Rs 2.02 lakh for the medical expenses. However, on May 22, 2020, the insurance firm rejected the claim. The rejection letter cited a policy condition, arguing that since the complainant had appeared for exams during treatment, it indicated he did not require hospitalization.
In response, the boy and his father approached the Surat CDRC on January 13, 2021, seeking the claim amount along with compensation for mental harassment and litigation costs. During the hearings, the boy's advocate argued that the doctor's permission was a special exception made solely to protect the student's education, and the illness was indeed severe.
Court's Observations and Ruling
The court carefully examined the circumstances and noted the student's courage in facing exams during a critical health condition. In its ruling, the commission stated, "When a Class 10 student appears for his board exams during a serious illness, you should appreciate his courage and give him the best service in a critical condition." It further criticized the insurance firm's decision, saying, "The act of rejecting the claim does not appear logical or judicious."
The Surat CDRC ordered New India Assurance to:
- Pay the claim amount of Rs 2.02 lakh with 8% interest from the date of filing.
- Compensate Rs 12,000 for mental and physical harassment caused to the family.
- Cover Rs 8,000 in litigation expenses.
This case highlights the importance of empathetic handling of insurance claims, especially in scenarios involving students' academic commitments during medical emergencies. The ruling serves as a reminder to insurers to consider human aspects alongside policy clauses.
