Jodhpur, 23 October (Read News). Permanent Lok Adalat, Jodhpur Metropolitan in its decision has ruled that it is unfair to reject the mediclaim claim of brain hemorrhage on the basis of alcoholism and high blood pressure. Court President Sukesh Kumar Jain and member Manaklal Chandak, while accepting the complaint, directed Max HDI General Insurance Company to pay the claim amount of Rs 19 lakh 32 thousand 86 and complaint expenses of Rs 5 thousand to the applicant within two months, otherwise 8 percent interest should be paid.

Meena Soni presented the claim through advocate Anil Bhandari and said that on June 6, 2023, while her husband was teaching their son to swim in the morning, when he suddenly felt unwell, he fell unconscious and suffered brain hemorrhage. The insurance company rejected the claim saying that the patient was suffering from alcoholism and high blood pressure and by hiding this his mediclaim policy had been cancelled.

Advocate Bhandari said that if the doctor of Mahatma Gandhi Hospital has declared the insured to be suffering from high blood pressure or obesity, then it cannot be assumed that he had this disease before the insurance policy. He said there was no link between alcohol or high blood pressure to the brain hemorrhage and the insurance company failed to prove the amount of alcohol involved. The insurance company said that due to many discrepancies in the claim, the claim has been rightly rejected.

While accepting the case, the Permanent Lok Adalat said that there is no mention in the patient’s treatment slip as to how long he has been suffering from high blood pressure. He said that the insurance company was also unable to produce the introduction form and the disease was not written in small letters on the printed paper attached with the policy, and it was not even signed by the insured. He said that the insurance company also failed to prove the amount of alcohol consumed and whether it had any connection with the brain hemorrhage.

Describing the rejection of the claim as unfair, he directed the insurance company to pay the claim amount of Rs 19 lakh 32 thousand 86 and complaint expenses of Rs 5 thousand to the applicant within two months, otherwise 8 percent interest should be paid.

(udaipur kiran) / Satish