Mumbai: Consumer Forum Orders Insurance Firm To Settle ₹10 Lakh Medical Claim Of Minor |
The Mumbai suburban District’s Consumer Dispute Redressal Commission has pulled up the National Insurance Company for the delay it caused in paying the medi-claim amount to one of its Vile-Parle based consumer. The Commission has thus asked the firm to pay the consumer with the interest towards the delayed payment along with Rs 25,000 towards mental agony and Rs 10,000 towards the litigation charges.
The commission while referring to the law books held, “In the cases of delay in payment, the insurer shall be liable to pay interest at a rate which is two per cent above the bank rate prevalent at the beginning of the financial year, in which the claim is reviewed.”’
A case was registered by Prakash Rathod against the National Insurance Company.
As per the complaint, Rathod had purchased medi-claim policy from the company since 1998. In the year 2007, Rathod had sought some treatment from the Asian Heart Institute, and a cashless claim of Rs 2,35,000 was raised for the same. The Insurance firm, had immediately issued an advance amount of Rs one lakh to the Institute, but the remaining of Rs 1,35,000 remained unpaid.
Rathod further said that he had to personally approach the insurance firm a number of times for the release of the remaining amount of the medical bill and finally Rs 35,000 and Rs one lakh was released by the firm in the year 2012, and year 2014, subsequently. Referring it to be a delay in providing service towards its consumer as well as for failing to provide appropriate service towards its consumers, Rathod had approached the commission against the insurance firm.
The complaint was opposed by the insurance firm, stating that, ”The delay was caused due to the time taken for recommendation and sanction from higher authorities. They have paid Rs 2,35,000to the complainant towards full and final settlement of the claim under the policy. So, the complainant should have refrained himself from filing the present complaint. “
The commission however turned down the arguments put forth by the insurance firm and asked them to compensate towards the delay caused.
