Yamunanagar: Insurance firm told to settle consumer’s medical bill claim

Yamunanagar, February 27

The Yamunanagar District Consumer Disputes Redressal Commission (DCDRC) has told an insurance company to make the payment of medical bill claim of Rs 26650 to a complainant of Yamunanagar.

Charges

• The complainant alleged his repudiation of claim is an act of gross negligence, deficiency in service, and also an unfair trade practice by the opponent, which caused him mental agony, harassment, financial loss, leading him to file the present complaint†

The DCDRC has also awarded a punitive damage of Rs 10,000 to the insurance company to compensate the complainant in all heads.

The order was passed by Gulab Singh, president of the DCDRC, Sarvjeet Kaur and Jasvinder Singh, both members, on February 20.

As per the order of the DCDRC, the complainant, Rupak Gupta of the Jagadhri Workshop area availed health insurance policy from the insurance company, known as ‘family health optima insurance plan’ for the period February 17, 2023, to February 16, 2024.

The policy was in continuation of an earlier policy for the period February 17, 2021 to February 16, 2022 and another policy for the period February 17, 2022 to February 16, 2023.

During the validity period of policy, the complainant was hospitalised for the treatment of pneumothorax, (suffering from chest pain), for the period of four days from March 3, 2023, to March 6, 2023.

The complainant incurred Rs 26,650 on his treatment during the period of his hospitalisation and by submitting all requisite documents, he raised medi-claim of Rs 26,650 with the opponent under the policy.

However, the opponent repudiated his claim on the ground that the documents submitted by the complainant, showed that he was suffering from various discrepancies and treatment of the insured patient was not transparently evident.

In his complaint, the complainant alleged his repudiation of claim, is an act of gross negligence, deficiency in service and also an unfair trade practice by the opponent, which caused him mental agony, harassment, financial loss and constrained him to file the present complaint.