Companies cannot reject claim for hospitalization intimation failure

Claim cannot be rejected for failure to intimate hospitalization in medical emergency. Consumer forum directs recovery of compensation from erring officials

The forum held both the insurance company and the TPA guilty of deficiency in service and unfair trade practice. It ordered payment of the claim amount of Rs 1,58,174 along with 9% interest from August 31, 2010. Additionally, the forum awarded Rs 8,000 as compensation for harassment and agony, and Rs 3,000 as costs.

The forum also directed an inquiry to be conducted and the compensation of Rs 8,000 proportionately recovered from the salaries of those officers who are found guilty of causing harassment and indulging in unfair practice. A compliance report must be filed within six months.
Impact: Maximum number of complaints at the level of the district forum are against insurance companies. Yet, there is no improvement in the attitude of insurance company officials because compensation is paid by the firm for their misdeeds. A change can be expected only if compensation pinches the pockets of erring officials. Hopefully, this judgment should start the beginning of a practice that could bring about a change in the system and compel insurance companies to behave responsibly.

 

Click Here for full details of the case and the judgement – Jehangir Gai – Times of India 070714

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