Insurer directed to pay Rs 6 L for rejecting claim

MADURAI: Thoothukudi District Consumer Disputes Redressal Commission directed a health insurance company to pay a sum of Rs 6,12,904 to an aggrieved consumer for rejecting the claim and causing deficiency in service, sources said on Tuesday.

Ezhilarasi, the complainant, a retired bank manager in Thoothukudi, availed a health insurance policy for her entire family. Earlier, her husband Ariyanayagam suffered a cardiac problem and was admitted to a private hospital in Thoothukudi.

Later, when his health deteriorated, Ariyanayagam got medical treatment in a private hospital in Chennai.

The policyholder paid medical bills for the treatment. Based on insurance coverage, she waited for the insurance firm to reimburse his medical costs. But much to her disappointment, the insurance firm did not reimburse her any money.

At last, she asked for the reason for the denial of reimbursement, but the firm refused his claim with no valid reason and cancelled the insurance policy too.

The dejected policyholder then sent a legal notice to the insurance firm through the commission, but there was no response. She then filed a case with the commission seeking action against the insurance firm.

After examining, the President of the Commission Chakravarthy and its members, Sankar and Namachivayam directed the insurance firm to revise the cancelled insurance policy, reimburse the medical bills of Rs 5,61,904 to the complainant and Rs 50,000 for causing her mental agony and deficiency in service and a compensation of Rs 10,00 towards the cost of expenses, sources said.