Page 53 - The Insurance Times September 2024

owners are unable to renew their insurance policies with- but the insurance company rejected his claim. He reapplied
out an updated PUC certificate. This situation leaves many on June 2, 2019, including doctors' opinions that hospital
without compensation claims in case of road accidents. admission was necessary.
Mehta explained that PUC certificates are valid for six Despite two insurance company employees visiting the hos-
months, whereas insurance policies typically need to be pital and reviewing records, the company maintained that
renewed annually. This discrepancy has caused practical his treatment could be managed on an outpatient basis and
challenges for vehicle owners and insurers alike. denied cashless treatment. Singh was discharged on June
9, 2019, and due to financial constraints, borrowed money
Responding to these concerns, the Supreme Court has now
recalled its 2017 order. This means that a valid PUC certifi- from siblings to cover the bills. He applied for reimburse-
cate is no longer mandatory for the renewal of third-party ment on June 22, 2019, submitted original bills on Septem-
ber 2, 2019, but his claim was again rejected in December
insurance policies. However, it's important to note that
without a specified reason.
under the Motor Vehicles Act, possessing a valid PUC cer-
tificate remains compulsory for driving any vehicle in India. The insurance company argued that hospitalisation was un-

While this new order provides relief to many vehicle own- necessary and the claim was non-payable. However, the
commission upheld the treating doctor's opinion, empha-
ers and addresses the practical difficulties highlighted by the
sizing the urgency of Singh's admission and the potential
GIC, it does not negate the legal requirement of having a
PUC certificate while driving. Vehicle owners must ensure for severe health repercussions if untreated. The commis-
they carry a valid PUC certificate at all times, as mandated sion concluded that Singh's condition warranted hospital
care and criticized the company's decision.
by law, even though it is no longer a prerequisite for re-
newing their insurance policies. This ruling reinforces the importance of insurance compa-
This decision marks a significant shift in the regulatory land- nies honoring legitimate claims and provides a reminder of
scape, balancing the need for environmental protection the consumer's right to fair treatment.
with practical considerations for vehicle insurance renew-
als. Diabetes as a Lifestyle Disease: Insur-

ance Claim Cannot Be Rejected
Denying Medical Claim Costs Insurance
The state consumer commission ruled against Oriental In-
Firm Dearly surance Co Ltd (OICL) for rejecting a mediclaim based on

The district consumer disputes redressal commission has pe- non-disclosure of pre-existing conditions, including diabetes
nalized United India Insurance Company for unjustly deny- mellitus (DM) and coronary artery disease. The commission
ing the medical claim of Kulwinder Singh, a resident of upheld the complainant's argument, referencing a national
Goslan village, Samrala. The commission ordered the insur- consumer commission decision that deemed diabetes a
ance company to pay Rs.79,606, covering hospital bills, with lifestyle disease, too prevalent to justify denying an insur-
an 8% annual interest rate and an additional composite fee ance claim entirely.
of Rs. 20,000 to Singh. Anshul Garg purchased a Rs 2 lakh mediclaim policy in 2013.
Kulwinder Singh approached the commission on June 28, In 2014, his father underwent cardiac surgery costing Rs 5
2021, regarding a cashless treatment insurance policy pur- lakh. Garg's claim was denied by OICL, leading him to ap-
chased through PolicyBazaar. The policy, valid from June 27, proach the consumer court. The district consumer commis-
2018, to June 26, 2019, insured him for Rs.1 lakh at a pre- sion ruled in favor of Garg, ordering OICL to pay Rs 2 lakh
mium of Rs.2,006. plus interest and litigation expenses. OICL appealed the
decision.
On May 31, 2019, Singh experienced severe stomach pain
and consulted a local physician, who prescribed medication. The state commission found no credible evidence from OICL
As his condition worsened, he was admitted to Dayanand to support their claim of concealment of pre-existing illness.
Medical College and Hospital (DMCH), where he was The commission noted that OICL failed to prove that Garg's
treated for acute pancreatic disease, loose motion, and father had diabetes for 15 years, which allegedly caused
fever. Singh applied for cashless treatment on June 1, 2019, the coronary artery blockage.

48 September 2024 The Insurance Times