The Hindu : New Delhi News : Insurance company fined

Online edition of India's National Newspaper
Tuesday, Apr 12, 2005

New Delhi

New Delhi

Insurance company fined

By Mandira Nayar

NEW DELHI, APRIL 11 . This was one hospital bill that Jasbir Singh would never really forget. Having been admitted to hospital for a heart bypass surgery, he had thought that his mediclaim policy would come to his rescue. But instead of coming to his aid in his hour of need, United India Insurance refused to pay his hospital bill and forced him to fight a long battle in court.

A consumer disputes redress forum has now held the insurance company guilty of deficiency in service and directed it to pay the insured amount of Rs. 1 lakh with interest at 9 per cent from the date of the order. The company has been further directed to pay Rs. 5,000 towards compensation for the harassment caused along with Rs. 1,000 as litigation costs to Mr. Singh. In his case before the court, Mr. Singh argued that he had taken a mediclaim policy for one year in 2002 and renewed it for the next year. He was insured for Rs. 1 lakh and had opted for an additional coverage of Rs. 10,000. After suffering chest pain he was admitted to National Heart Institute in 2002 and had to undergo bypass surgery. He lodged the claim amount with the insurance company through a letter, he claimed. However, the company wanted to examine the records before they gave the money, which he consented to, he alleged. He further claimed that the company wanted to inspect the records of his visit to Holy Family Hospital in 1994, which he also consented to, despite the fact that he had not been treated for a heart ailment there. For their part, the insurance company has argued that its panel doctor verified the records of the hospital and found that Mr. Singh had been admitted to Holy Family Hospital in 1994 for a heart-attack and had been going to National Heart Institute for a regular check up.

After going through all the evidence, a bench of the consumer disputes redressal forum stated that the observation of the panel doctor of the company was not based on any records.

There is no record at the National Heart Institute that shows that Mr. Singh had been hospitalised earlier at Holy Family Hospital and was under a follow-up treatment with them, hence the insurance company was guilty of deficiency in service for not paying the mediclaim amount, the bench held.

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