NEW DELHI: In a landmark judgment, the National Consumer Disputes Redressal Commission (NCDRC) has ordered Life Insurance Corporation of India (LIC) to pay Rs 1,60,812 to an insured who fought for 8 years over ‘Jeevan Arogya’ insurance. The controversy arose when the LIC chief deemed the hernia surgery for which the insured was claiming reimbursement as trivial, resulting in a paltry sum of Rs 17,100 against an expenditure of Rs 2,16,827.
The 'Jeevan Arogya' health insurance policy, a non-linked plan, covers specified health risks and offers benefits such as financial protection during hospitalization and surgery, increasing health cover annually, lump sum benefits regardless of actual medical costs, no claim benefits, flexible benefit limits, and premium payment options.
The policyholder’s struggle began in 2016 when he submitted a claim for his father’s hernia surgery, costing Rs 2 lakh but LIC reduced the claim, asking for an abdominal hernia surgery is not included under the 'major surgical benefit' list.
Besides, LIC said the father had not mentioned hypertension and coronary artery disease while filling the application form. In 2018, the battle moved on to the District Consumer Forum, where LIC’s stand was rejected. The meeting directed LIC to pay Rs 1,60,812 to the policyholder, confirming that the waiting period for hernia surgery under the scheme was two years and the surgery was performed five years after the purchase of the policy.
Despite the unfair verdict, LIC remained adamant and appealed to the National Consumer Commission, which in turn ruled against them in January 2020. Dissatisfied with the verdict, LIC filed the appeal appealed to the NCDRC again.