A district consumer commission has directed the New India Assurance Co Ltd to pay ₹42,011 mediclaim to a father who was partially denied the claim incurred on the treatment of his son.
The order dated January 30, 2022 was passed by Preethi Chamikutty and Shraddha Jalanapurkar, members of the suburban consumer forum on a complaint filed by Wahid Khatri against the insurer.
Had submitted claim after son's surgery
The Jogeshwari resident had submitted a claim of ₹45,234 after his son underwent surgery for an ear nose throat (ENT) problem. The insurer just cleared ₹17,011 via cheque which was returned by Khatri. The primary reasons given for not fully approving the claim were that the doctor's fee was not included in the policy and a circular mentioning the change in policy was issued on September 22, 2008. The claim was submitted the next day, said the insurer, adding that an intimation regarding policy change was already released on September 5, 2008. It had further underscored that approving Khatri's claim will be injustice to other contributing policy holders.
Change of policy not intimated to complainant: Commission
During the hearing, the commission stated that the doctor's fee was covered in the policy and insurer “informed about the circular only through an agent without intimating the complainant about the changes in terms and conditions of the policy”.
The commission said that the change in policy was not intimated to the complainant and hence there was deficiency in service for which they should be paying ₹30,000 towards mental agony and litigation cost.
