National Insurance directed to refund amount for faulty policy renewal

A district consumer commission has directed National Insurance Co Ltd to give an insurance claim that was denied to the complainants after a wrong policy was issued post renewal and without the approval of a competent authority. The commission directed that ₹2.02 lakh be given with 6% interest per annum, along with ₹35,000 towards mental agony and litigation costs. The order was passed on a complaint of Dilip Chheda and Nayana Chheda against the insurer.

Chheda availed a National Parivar Mediclaim Plus policy (floater mediclaim policy) for ₹50 lakh insurance. He had submitted documents pertaining to a pre-existing disease declaration as per the proposal and a medical check-up from the authorised centre of the insurance company was also done. The policy was for 2018-19.

All required tests done for renewal of policy

The Chhedas renewed the policy after paying ₹2.12 lakh and the amount got debited on July 23, 2019. All required tests were done again which the Chhedas paid for. However, despite paying the premium, they did not receive the policy. They followed up and asked that the policy be given or the premium be refunded.

The firm sent the policy for post facto approval and got approval for insurance of ₹10 lakh only. A complaint with the IRDA and Ombudsman was made. The insurance firm refunded ₹1.41 lakh, which the complainant received under protest. The Ombudsman passed an order to give the remaining amount with 2% interest but rejected the claim for the first one.

Company rejected insurance claim

While the insurance firm refunded the premium amount for the second year, it did not clear the insurance claim. The commission, during the hearing, observed that the firm on one hand issued a renewal notice and then did not take approval from the competent authority, showing a deficiency in service at their end. It then went on to direct the compensation.

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