Pay Rs 20,000 to policy holder, insurance firm told – The Hindu – 12th November 2018

Holding United India Insurance deficient in services, a consumer disputes Redressal forum here has
directed the insurance company to compensate a policy holder by paying over Rs20,000 for “wrongly
repudiating” a claim.
Stating that the insurance company’s contention that the policy holder’s claim was under the “exclusion
claim”, the consumer panel said, “This forum is of the opinion that the ailment or disease of the
complainant is not covered under [relevant] clause of the policy and the opposite party has wrongly
denied claim. Thus, holding guilty of deficiency in services, we direct [insurance company] to pay Rs
20,000 as compensation for harassment and mental agony.”
Complainant Kaushlender Ojha had alleged that despite having a mediclaim policy, the insurance
company had refused to pay the claim of over Rs 31,000 raised by him.
“The complainant alleged that on account of… severe pain in the stomach, he approached Jaipur Golden
Hospital through emergency and remained in the hospital and took treatment for [the] ailment,” read the
complaint in the order.
Further it was alleged that despite sanctioning the amount, the insurance company “unlawfully declined
the payment of the claim” later.
The insurance company had however contended that resolving appendicitis “did not warrant
hospitalisation” and hence, the complainant was not entitled to a refund of the claim.
Dismissing the insurance company’s contentions, the consumer panel has directed the company to
compensate the policy holder by November 26, failing which an interest of 10% per annum will be levied. Read More

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