Insurer fined for denying claim

Tribune News Service

Amritsar, September 10

The District Consumer Disputes Redressal Forum has fined an insurance company for repudiating the claim of a patient. The firm will have to pay Rs 80,461 along with Rs 3,000 as compensation and Rs 2,000 as litigation expenses to complainant Virender Dhiman, a resident of Park Avenue.

Dhiman had filed his complaint against Family Health Plan Limited stating that he had purchased a health insurance policy for his family. In June last year, his mother fell down on the floor all of a sudden and since she expressed her inability to even move, the complainant got her hospitalised later.

The complaint said the cashless medical treatment facility was denied without any valid reason, so he had to pay Rs 80,461 to the hospital.

After the patient was discharged from the hospital, Dhiman contacted the opposite party which asked for a few documents and even a representative of the company recorded the statement of his mother. He complained that even after completing all the formalities, the company didn’t pay him the insurance claim.

The insurance company did not appear before the forum. The forum observed that the insurance company had stated that there was no reason for hospitalisation. However, the hospital in a certificate before the forum stated that the patient was admitted because of her medical condition.

The forum stated that the stand taken by the opposite party for the denial of the claim stands rejected as the complainant has produced on record certificate of the hospital which proves that the patient needed hospitalisation. The forum stated that insurance companies showed green pastures to people at the time of selling insurance policies but when it came to payment of insurance claim, they invented all sort of excuses to deny.