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

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Yamunanagar, March 8

The District Consumer Disputes Redressal Commission (DCDRC), Yamunanagar, has told a health insurance company to make the payment of treatment bills amounting to Rs 46,784, to a woman (complainant) of Yamunanagar.

Inaction

At the time of discharge from the hospital, the complainant intimated and requested to the health insurance company for availing the facility of cashless payment. She fulfilled all the formalities and submitted necessary documentation to the insurance company, but no action was taken by the opponent.

The DCDRC has also awarded a punitive damage of Rs 15,000 to the health insurance company to compensate the complainant in all heads. The order was recently passed by Gulab Singh, president of the DCDRC, Sarvjeet Kaur and Jasvinder Singh, both members.

As per the judgment of the DCDRC, the complainant, Renu Mann of Jagadhri purchased a health insurance policy for the period of November 11, 2022, to November 10, 2023, from the company with a sum of Rs 5 lakh assured.

The complainant said she suffered a pain in abdomen on July 2, 2023.

She got an ultrasound done and as per the report, she was suffering from some serious problems, including fatty liver and a solitary gallbladder stone.

On the advice of the doctor, she was admitted to a private hospital for the surgery of cholelithiasis acute eostroentiritis through the procedure of laparoscopic cholecystectomy.

At the time of discharge from the hospital, she intimated and requested to the opponent (health insurance company) for availing the facility of cashless payment. For this purpose, she fulfilled all the formalities and submitted necessary documentation to the insurance company, but no action was taken by the opponent.

“I was very surprised to see that the opponent sent the original bills as well as treatment record back along with rejection letter dated August 28, 2023, without any reason. It is an act of negligence, deficiency in service, on the part of the opponent, caused me mental agony, harassment and financial loss,” alleged the complainant.