An insurance agent was awarded Rs 8,000 compensation by a district commission for financial loss and mental agony he suffered due to a delay in releasing of claim amount by National Insurance Company Ltd. on his medical treatment bill. The Company and TPA had released the claim after 99 days instead of 30 days. The district consumer commission directed that the amount be given within 15 days of the order else an interest of nine percent per annum will have to be paid.
The order dated November 16, 2022 was given by RG Wankhade, president and SV Kalal, member of the Additional Mumbai Suburban District Consumer Disputes Redressal Commission on a complaint by Kandivali resident, Kailashnath Dubey against National Insurance Company Ltd. and Medicare TPA Service (I) Pvt.
Dubey, an agent of National Insurance, had taken a health insurance policy with a duration of August 28, 2016, to August 27, 2018. During the term of the policy, he met with an accident and had undergone medical treatment in a hospital. Despite repeated requests when Dubey did not get the claim amount, he sent a notice in May 2017. The company eventually gave him the claim amount after a delay in July 2017.
In his complaint to the commission, Dubey stated that his claim should have been decided in 30 days and that was not done. He contended that during the delay he had to take out a loan to pay for his hospital treatment expenses that were not returned to him. Dubey had made a claim of Rs Rs 47,979/-, submitted bills of Rs 46,142/- and the claim money of Rs 24,692 was given through NEFT after going through the terms and conditions of the policy.
During the hearing, the Insurance Company contended that the delay in disbursing the claim amount could be due to accounts department personnel being on leave. Stating that such an argument is not appropriate, the Commission observed that the Company's reply is expected to come in 30 days. It said that there was a deficiency in service and directed compensation to be paid.