Dist consumer forum tells HDFC Bank to pay Rs 1.3 lakh

Avneet Kaur

Jalandhar, July 13

The District Consumer Disputes Redressal Forum has directed HDFC EGRO General Insurance Co Ltd to pay Rs 1, 03,841 with 12 per cent interest to a local resident on the ground that he got injury due to accident and remained admitted in the hospital for which he has complete evidence and bills. The forum has also directed the company to pay compensation for mental harassment to the complainant, to the tune of Rs 15,000 and litigation expenses of Rs 5,000.

Raja Ram Jha, a resident of 23-D Link Road, Model Town, had filed a complaint against HDFC Bank, wherein he alleged that he obtained individual health Suraksha Policy Silver Plan covering risk of domiciliary treatment, emergency ambulance charges, health check-up to reimburse to the insured person expenses incurred in patient’s treatment, and expenses for any medical/surgical treatment at any hospital/nursing home and among other expenses. Ram Jha said he had been continuously and uninterruptedly insuring himself since 2014 without any gap.

Advocate of Raja Ram Jha KC Malhotra said on January 1, 2016, Jha met with an accident in the vicinity of Green Park, Near Bus Stand, Jalandhar while driving scooter. He sustained injuries and remained admitted in the DMC Hospital and Trauma Centre SAS Nagar, Jalandhar from January 4, 2016 to January 20, 2016. After discharge from hospital, he submitted a claim of Rs 1,03,841 for reimbursement for hospitalisation and treatment surgery.

While, he also presented all the relevant documents to the bank, the bank unilaterally, repudiated his mediclaim amounting to Rs1,03,841 under Section 10 of policy terms and conditions on the pretext that mediclaim was found to be misrepresented and some manipulation with the accident dates has been done.

The bank in its reply stated that the certain discrepancies were found in the documents. According to the statement of the complainant, he met with an accident on 04.01.2016, but in the claim form, the date of accident was mentioned as 03.01.2016 and date of admission was 04.01.2016.

An investigation was conducted in order to confirm the genuineness of the claim, but discrepancies were ruled out by the investigator, which confirmed that the claim was manipulated, hence it was repudiated.

The forum also observed that by simply mentioning a wrong date in the form is alone not sufficient to discard the entire claim of the complainant. It might also be a typographical mistake, slip of pen and simply on this ground, the claim cannot be repudiated.

The forum also said that on the “ground of mentioning a wrong date of accident, it is not sufficient to consider that there was no accident. Therefore, the HDFC EGRO General Insurance Co Ltd is liable to pay a medical claim amount of Rs1,03,841 with interest rate of 12% per annum from the date of repudiation i.e. 21.06.2016, along with other litigation expenses.”