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Insurance firm told to pay over Rs.2 lakh for non-settlement of claim
The Hindu, May 23, 2019

Complainant had sought authorisation for cashless facility

Holding the National Insurance Company deficient in services for non-settlement of a mediclaim policy, a district consumer disputes redressal forum here has directed the insurance firm to compensate a complainant by paying over Rs. 2 lakh.

The directions came when city resident Hirdesh Kumar Varshney approached the consumer panel alleging that the insurance company had failed to settle a mediclaim policy for his treatment at the Jaipur Golden Hospital in Rohini.

“The complainant sought authorisation for cashless facility for the treatment of the complainant with the [insurance firm] but despite having the cashless facility for treatment, [the policy] was frivolously and falsely repudiated…therefore the complainant paid the entire bills issued by the hospital,” the consumer forum observed while noting the allegations made in the complaint.

A bill of over Rs. 3 lakh, including cost incurred for post-hospitalisation treatment, was raised by the complainant, the Bench noted. “The complainant had sent several emails and letters regarding the reimbursement of the claim but the claim has neither been accepted nor rejected till date by the [insurance firm],” read the complaint in the order.

Unrebutted testimony

Noting that the insurance firm failed to respond to the allegations, the district consumer forum observed, “From the unrebutted testimony of the complainant and documents placed on record, we are convinced that the story put forth by the complainant is true.”

Stating that non-settlement of the claim “amounts to deficiency in services”, the consumer panel directed National Insurance to pay an additional sum of Rs.25,000 as compensation towards harassment, mental agony and pain.

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