Insurance co fined for not paying full mediclaim amount
30 Jan, 2014 12:12 PM
The south Mumbai district consumer forum came to the rescue of a mediclaim policy holder who had undergone a cataract surgery and was paid Rs 10,000 less than his claim amount by the insurance company and a third party agent.

President of the forum S M Ratnakar and member G H Rathod on Tuesday ordered the New India Assurance Co to pay Rs 10,000 to Navnit Raithatha along with 9% interest since the date of the claim in 2006. Raithatha had approached the forum in 2007 with a plea that the company and Raksha TPA be declared guilty of deficiency in service and unfair trade practice as per the Consumer Protection Act.

Raithatha had taken a joint mediclaim policy from the New India Assurance. He underwent a surgery of both eyes in January 2006 at Parekh Hospital and submitted his claim of Rs 90,000. But he received a cheque of Rs 80,000 only. The company said it had rightly deducted Rs 10,000 as per policy conditions. Raithatha accepted the amount under protest and when pleas to reconsider proved futile, he approached the consumer forum.

The forum held that the company had "improperly repudiated the genuine claim of Rs10,000". "In our view therefore, the opposite parties are liable to pay the deducted amount of Rs10,000 with interest," it said.

It directed New India Assurance and Rakhsa TPA to pay Rs 5,000 to the complainant as compensation towards his mental agony and another Rs 3,000 as litigation cost within a month.
Source : The Times Of India

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