Mumbai: The District Consumer Disputes Redressal Commission, Central Mumbai, has directed an insurance firm to pay the medical claim amount of Rs39,802 to a complainant (now deceased) with 3% interest per annum from June 2018 till realisation of the amount. Additionally, Rs8,000 would be given for mental agony and litigation costs.
The order was passed by the Commission on a complaint of Salma Imam (now deceased, and through legal heir Ali Imam Hussain) against Star Health and Insurance Company Ltd and one Sheela Panikar. However, there was no order against Ms. Panikar.
Ms Imam, a senior citizen and a retired principal, had taken a Senior Citizen Red Carpet Health Insurance Policy from Star by paying a premium of Rs20,700 from June 4, 2016 to June 3, 2017. The policy was from a year prior and continued.
In May 2017, she was admitted to Holy Family Hospital for Parkinson’s. When the hospital sent the claim, it was rejected by only stating that it didn’t meet certain conditions. The same was communicated to Ms Imam. When she left the hospital, she cleared the bill of Rs56,861.
Ms Imam wrote to Star but didn’t get any reply. Later, Star cleared Rs22,585 when Rs39,802.70 was sought as the actual expense amount. The firm then cleared over Rs12,000.
During the hearing, Star stated that the claimant would have to take 50% expense in case of pre-existing illness and 30% in case of other illnesses. The Commission observed that not replying to the complainant on time and coming out with different figures for claim showed deficiency in service.
