The state consumer disputes redressal commission has asked a public sector insurance company to clear a claim it had rejected.

Bijoy Kumar Agarwala, a Jalpaiguri resident, had bought a medical insurance policy from New India Assurance Company Ltd for himself, wife Meena Devi and son Deepak in October 2001. The sum assured was Rs 50,000 for each.

In 2004, Meena Devi underwent a renal transplant at Apollo Hospital, Chennai. But she fell ill again a few days after her return and was on dialysis at Peerless Hospital for 12 days.

Agarwala had claimed Rs 1.07 lakh from New India Assurance. But the company rejected the claim, saying Meena Devi was diagnosed with hypertension, ischaemia and other ailments 20 years before the policy was issued.

“The respondent (New India Assurance) failed to adduce any evidence to prove that she was treated for hypertension,” the commission said in its order. “There is no proof that the ailment of the appellant was pre-existing before taking out the policy.”

The commission has asked New India Assurance to pay the Rs 1.07 lakh that Agarwala had claimed.

“We are considering moving the National Consumer Disputes Redressal Commission against the ruling,” said a New India Assurance official.

Agarwala’s is not the only case of a medical insurance company turning down a “bona fide” claim.

Complaints from aggrieved policy-holders are flooding the state consumer commission and its district branches, said an official. “Twenty per cent of the cases filed with the panel are on medical insurance.”

Prabir Basu, a member of the state government’s consumer protection council, said: “Medical insurance companies should accept genuine claims. They seem to have developed a tendency to reject claims on technical grounds.”

Members of the medical fraternity echoed Basu’s views. “The Third Party Administrators (appointed by insurance companies to verify claims) reject 70 per cent of the applications citing pre-existing diseases. Most of the rejected claims are genuine,” said Sudipto Mitra, the medical superintendent of Peerless Hospital.

The insurance firms, however, argued that several policy-holders fake illness and get themselves admitted to clinics for routine tests that are not covered by the policy. At times, false bills too are submitted.