New India Assurance to pay Rs 60k for denying mediclaim

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State-run New India Assurance has been ordered by a consumer forum to pay over Rs 60,000 to one of its mediclaim policy holders for its failure to reimburse expenses worth Rs 45,252 on his son's hospitalisation.

Beside ordering to reimburse North Delhi resident Shiv Kumar Gupta's expenses on his son's hospitalisation, the Central District Consumer Disputes Redressal Forum also asked the firm to pay him Rs 10,000 as compensation against harassment and mental agony and Rs 5,000 as litigation cost.

"The act of the insurance company has caused not only financial losses but harassment, pain and mental agony to the complainant.''

"It is despite the fact that the insurance company has received the policy premium and when the benefits were required to be extended to the complainant/family members then it closed the claim without any valid reason," said the forum, presided by B.B. Chaudhary.

The forum's order came on a plea by Gupta, who had purchased a mediclaim policy for himself and his family members from New India Assurance Co Ltd for period from April 16, 2010 to April 14, 2011.

He said he had informed the third party administrator (TPA) of the insurance company on December 7, 2010, regarding his son's hospitalisation and had submitted his claim of Rs 45,252 with requisite documents on December 10, 2010.

He was assured that his claim was being processed, he had said adding he was never told there was any deficiency in the documents.

The insurance company said it had closed Gupta's claim as he had not provided the doctor's prescription slip and IPD paper despite reminders.

The insurance company's defence was rejected by the forum presided by B.B. Chaudhary, which held that the requisite papers were provided by Gupta and as the insurance company and its TPA failed to prove they had sent reminders to him, closing of the claim was not justified.