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

Background: A mediclaim policy requires the insured to intimate the insurance company or the TPA about a hospitalization. There are times when a medical emergency may arise, where the priority is to get the patient admitted and treated, rather than waste time in digging out the policy to send an intimation about the hospitalization. In such a case, the insurance company attempts to capitalize on the non-intimation by rejecting the claim. This is not permissible as recently held by the South Mumbai District Consumer Forum in the case of Consumer Welfare Association & Anr v/s United India Insurance Co & Anr.

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 the full story by Jehangir Gai – Times of India


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