'Take it or leave it attitude' of insurance companies unwarranted: Consumer Commission

Observing that the ‘take it or leave it’ attitude of the insurance companies are unwarranted, the District Consumer Dispute Redressal Commission directed an insurance firm to pay Rs 15,000 as compensation to a city resident for denying the claim without valid reasons.

The commission also directed to reimburse an amount of Rs 54,228, spent on the treatment, to the complainant along with an interest of 9 per cent per annum.

The commission said it is generally seen that the insurance companies are only interested in earning premiums and find ways and means to decline claims.

In his complaint, Sanjiv Rana, a resident of Sector38, stated that he obtained a health insurance policy and on April 10, 2024, visited a private hospital in Mohali for consultation after feeling uneasiness.

As there was no relief, he again approached the hospital and was advised admission.

At the time of discharge, the hospital filed a claim with the insurance company but it was rejected. As per bills, the complainant had to pay Rs 54,228 for his medical treatment from his own pocket.

Despite notices, the insurance company did not put in appearance before the Commission and accordingly they proceeded against ex-parte vide order dated October 30, 2024.

The Commission said there was no merit on the grounds of the company for denying the claim that the need of the hospitalisation was not established based on the lab reports.

The Commission said it is for the treating doctor/hospital to see if hospitalisation is needed for the patient or not.

After hearing the arguments, the Commission held the company guilty of deficiency in services and directed it to reimburse the amount and pay compensation to the complainant for the harassment and litigation expenses.