Home Insurance Consumer court directs insurance firm to pay mediclaim of ₹40,000 to patient

Consumer court directs insurance firm to pay mediclaim of ₹40,000 to patient

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A Consumer court in Ludhiana, Punjab directed an insurance firm to settle the medical claim of ₹40,000 after finding that the company covered only partly the complainant’s medical bill.

According to a report by the Hindustan Times, the patient Manjit Singh Chahal had undergone surgery at Columbia Asia Hospital, Patiala in 2018. The cost of his surgery had stood at ₹1,28,546 of which the insurer paid ₹85,918 and Chahal had to pay around ₹42,000 from his pocket.

Chahal had requested the District Consumer Disputes Redressal Commission to settle his claim and pay him a compensation of ₹1,50,000.

The insurance company contended that the complaint was premature and that Chahal did not approach Park Mediclaim Insurance for the settlement of his claim nor did he deposit the receipt for the payment made.

According to the daily, the insurance company said, “The complainant should have lodged a complaint with the firm if the claim had been repudiated. On receipt of a request for cashless payment on September 10, 2018, permission to pay the hospital up to ₹40,000 was granted through a mail dated September 12, 2018. After the final bill of ₹1,28,546 was received, ₹85,918 was sanctioned. However, due to an inadvertent error, the total amount sanctioned ₹1,25,918 could not be communicated to the hospital, due to which it charged the difference from the complainant”.

However, the consumer court said, “The argument that the complainant should have lodged a regular claim does not appear to be tenable because it stands admitted on the part of the insurer that they intended to pay the final bill to the tune of ₹1,25,918 which was required to be paid directly to the hospital”.

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