Chandigarh: Court raps insurance company for repudiating claim on 'flimsy grounds'
TNN | Mar 12, 2019, 11:49 IST
Representative imageCHANDIGARH: District consumer disputes redressal forum directed Heritage Health TPA Private Limited Kolkata and United India Insurance Company to pay Rs 30,000 for repudiating the claim of a Dhanas resident on 'flimsy grounds'.
They were also directed to pay the claim repudiated, Rs.53,031, along with 9% interest per annum from September 6, 2017, till its realisation.
The complainant, Premi Devi, stated that she and her husband, a retired employee of Allahabad Bank, became member of medical insurance scheme introduced by Allahabad Bank for its existing/ retired personnel and accordingly, paid the requisite premium of Rs 14,950 to Heritage Health TPA, where after they were issued their respective health cards.
Accordign to her, she visited the hospital on August 22, 2017, as she was experiencing acute constipation problem. After complying with all the pre-requisites, as desired by United India insurance company, she got herself admitted on September 5, 2017. On the discharge of the complainant the next day, the hospital raised a bill of Rs 41,981. However, instead of paying its share of Rs 39,701 out of the total bill, the insurance company repudiated the claim on flimsy grounds on September 6, 2017. The hospital had later increased the bill to Rs 53,031 for the same treatment, which her son had to pay.
A notice was served to Heritage Health and the insurance company, but nobody appeared on their behalf. Therefore, they were proceeded ex-parte.
The forum stated that their "Non-appearance shows that they have nothing to say in their defence against the allegations made by the complainant. Therefore, the assertions of the complainant go unrebutted and uncontroverted."
The forum, after going through the documents put on record, observed that, "In the present circumstances, it is established beyond all reasonable doubts that the complaint is genuine and the complainant has been made to run from pillar to post for no fault on her part. The harassment suffered by the complainant is also writ large."
Observing that the accused have "certainly and definitely indulged in unfair trade practice, the forum said: "We feel that it was their duty to pay the genuine claim of the complainant, promptly, but they have miserably failed to do and rather propelled this unwarranted, uncalled for litigation upon the complainant."
The court further stated: "The act in not paying the genuine claim despite charging the requisite premium, proves deficiency in service on their part, which certainly has caused immense, mental and physical harassment to the complainant."
They were also directed to pay the claim repudiated, Rs.53,031, along with 9% interest per annum from September 6, 2017, till its realisation.
The complainant, Premi Devi, stated that she and her husband, a retired employee of Allahabad Bank, became member of medical insurance scheme introduced by Allahabad Bank for its existing/ retired personnel and accordingly, paid the requisite premium of Rs 14,950 to Heritage Health TPA, where after they were issued their respective health cards.
Accordign to her, she visited the hospital on August 22, 2017, as she was experiencing acute constipation problem. After complying with all the pre-requisites, as desired by United India insurance company, she got herself admitted on September 5, 2017. On the discharge of the complainant the next day, the hospital raised a bill of Rs 41,981. However, instead of paying its share of Rs 39,701 out of the total bill, the insurance company repudiated the claim on flimsy grounds on September 6, 2017. The hospital had later increased the bill to Rs 53,031 for the same treatment, which her son had to pay.
A notice was served to Heritage Health and the insurance company, but nobody appeared on their behalf. Therefore, they were proceeded ex-parte.
The forum stated that their "Non-appearance shows that they have nothing to say in their defence against the allegations made by the complainant. Therefore, the assertions of the complainant go unrebutted and uncontroverted."
The forum, after going through the documents put on record, observed that, "In the present circumstances, it is established beyond all reasonable doubts that the complaint is genuine and the complainant has been made to run from pillar to post for no fault on her part. The harassment suffered by the complainant is also writ large."
Observing that the accused have "certainly and definitely indulged in unfair trade practice, the forum said: "We feel that it was their duty to pay the genuine claim of the complainant, promptly, but they have miserably failed to do and rather propelled this unwarranted, uncalled for litigation upon the complainant."
The court further stated: "The act in not paying the genuine claim despite charging the requisite premium, proves deficiency in service on their part, which certainly has caused immense, mental and physical harassment to the complainant."
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