CONSUMER COURT FINES INSURANCE COMPANY FOR FAILING TO FURNISH MEDICLAIM BENEFITS

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The Hush Post: The District Consumer Disputes Redressal Forum,Chandigarh, has imposed a fine of Rs 10, 000 on New India Insurance Company for failing to furnish mediclaim benefits to a customer.  Sector-38 resident, Dr Pankaj Madan, had a family mediclaim policy in his name which he bought from New India Insurance Company in September 2015 which was valid till September 2016. He had paid a premium of Rs 6,179 for a health insurance cover of Rs 5 lakh. In his complaint Dr Madan had said that his wife was hospitalised on March 28, 2016 at Max Hospital, Mohali. After getting her admitted, Dr Madan informed the insurance company. The insurance company first refused the cashless treatment facility but then said that the claimant could claim the reimbursement after treatment.

Dr Pankaj’s wife was discharged from the hospital on March 30, 2016 and he then presented a bill of Rs 52,815 to the insurance company for reimbursement, but the company simply refused to pay. Dr Pankaj had thereafter approached the consumer court.

In its response, the insurance company alleged that Dr Pankaj had falsely used the hospital to claim money from the company. The court however set aside company’s claim and directed it to reimburse the whole medical bill amount and also a fine of Rs 10,000. The court also directed the company to pay an additional Rs 8,000 as court charges.

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