Mumbai: Consumer panel orders ‘reluctant’ TPA to pay MediClaim of ₹ 40,336

The consumer commission also ordered the third-party administrator (TPA) to pay Rs 13,000 in compensation towards mental agony and litigation costs to the complainant Vikas Naik.

Ashutosh M ShuklaUpdated: Monday, January 16, 2023, 09:16 AM IST
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Mumbai: Consumer panel orders ‘reluctant’ TPA to pay MediClaim of ₹ 40,336 | Representative Image

Mumbai: A district consumer commission has directed a third-party administrator (TPA) to give Rs 40,336 MediClaim to a complainant within 60 days of order or the same will have to be given with 6% interest per annum.

The commission also ordered Rs 13,000 compensation towards mental agony and litigation costs.

The order dated January 9 was passed by RG Wankhade, president of District Consumer Disputes Redressal Commission, suburb, and its member Shraddha Jalnapurkar on a complaint by Vikas Naik against Medi Assist India TPA Pvt Ltd and United India Insurance Co Ltd.

Complainant approached consumer panel when his claim was neither cleared nor rejected

Naik had taken a floater policy for himself and his parents for an amount of Rs 3 lakh. In 2014, Naik's father was admitted to a hospital for treatment and a claim of Rs 40,336 was raised. However, he filed a complaint with the Commission when his claim was neither cleared nor rejected.

In his complaint, Naik said that he had made two more claims but they were not fully cleared and filed a complaint for all of them with a total amount of Rs 80, 407 that included the uncleared amount of the two previous claims (of Rs 22,445 and Rs 13,774).

Complaint went unchallenged

During the hearing, the TPA and the insurance company did not put up any defence so the complaint went unchallenged. Stating that as per IRDA guidelines, the TPA should have given the claim, the Commission directed it to give the claim amount within 60 days of order as there was a deficiency in service on their part besides directing compensation that will have to be given by both.

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