Insurance firm asked to pay over Rs 5 lakh
10 Mar, 2014 04:04 PM
The Consumer District Forum has directed Oriental Insurance Company and its senior divisional manager and manager of Oriental Insurance, Manimajra, to pay a total claim Rs 5 lakh plus compensation and litigation charges to a Chandigarh resident. The order stated: "Repudiation done by the insurance company is totally unjustified and illegal, and the deficiency in service on the part of the company is writ large."

Ravinder Singh Bhalla, a Chandigarh resident, alleged that he had taken a PNB Royal Mediclaim Policy from Oriental Insurance Company worth Rs5,00,000 for hospitalization expenses and medical/surgical treatment at any nursing home or hospital across India. In July 2013, he was hospitalized at the Fortis Hospital in Mohali for treatment of coronary artery disease, where he had incurred an expenditure of Rs5,55,365. Ravinder filed his claim through M/s Medi Assist India TPA Private Limited, Mohali, for reimbursement of medical expenses with the Oriental Insurance Company followed by reminders, but instead, the company repudiated the claim.

The insurance company stated that the claim had been reported in the first year of the policy, whereas for two years, the claim for hypertension and its related conditions are not payable. They further stated that the claim was repudiated on the advice of TPA. According to the company, the patient was a known case of hypertension as evident from his medical certificate. Oriental Insurance was ordered to pay Rs 5,00,000 as the amount of insurance, Rs25,000 as part of compensation for causing him mental harassment due to a deficiency in their act, and Rs10,000 as litigation charges.
Source : The Times Of India

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