INDORE: District consumer dispute redressal forum directed 'The Oriental Insurance Company' to compensate two different consumers for cancelling their insurance claims without valid reasons.
Shiv Shaktinagar resident Kiran Kumar Mahajan purchased a health insurance policy from the company for his mother Nalini Mhajan and other family members, which was valid from August 2011 to August 2012. In November, 2012, Kiran's mother suffered from heart pain, and after angiography and angioplasty revealed two blockages, she was admitted to the hospital. Kiran paid Rs 1.93 lakh for the expenses incurred on the medical treatment. He asked the insurance company to compensate Rs 2 lakh under their scheme 'cashless service' but the company gave him only Rs 70,000.To claim the entire amount, Kiran presented all the bills of the hospital to the company but the insurance company made only additional payment of Rs 20,000. "Against claim of Rs 2 lakh, I was paid only Rs 90,000," said Mahajan.
Mahajan then moved the forum against the insurance company. Company claimed to have made the necessary payments and said in case of diabetes and hypertension-related diseases, full payments are made two years after hospitalization. But after scrutinizing all the documents, forum found company guilty of not providing money to the consumer under the policy. The forum directed the company to pay rest of the money with 8 % interest and Rs 4,000 for causing mental agony and litigation expenses.
Another consumer Sandep Bawniya moved the forum against oriental insurance company for cancelling his insurance claim and providing poor service. Sandeep Bawniya, purchased medi-claim under 'happy floater family' from the Oriental Insurance Company which was valid from August 2011 to August 2012. On February 2012, he got his father, who was suffering from heart-related problem, admitted to a city hospital and spent Rs 41, 925 on treatment. He asked the company to pay the claim amount, but the company denied. Even after several calls, company failed to reply. Following this, he moved the forum against the company and asked them to pay Rs 41, 925 with 9%interest and Rs 15,000 for harassing the consumer mentally. Since there was no reply from the respondent even after several notices issued, the contention of the complainant went unchallenged. Forum accepted the contention of the complainant as the documentary evidence. It directed the company to pay as per the company's clause with 8% interest and pay Rs 4,000 for mental and physical harassment.
Shiv Shaktinagar resident Kiran Kumar Mahajan purchased a health insurance policy from the company for his mother Nalini Mhajan and other family members, which was valid from August 2011 to August 2012. In November, 2012, Kiran's mother suffered from heart pain, and after angiography and angioplasty revealed two blockages, she was admitted to the hospital. Kiran paid Rs 1.93 lakh for the expenses incurred on the medical treatment. He asked the insurance company to compensate Rs 2 lakh under their scheme 'cashless service' but the company gave him only Rs 70,000.To claim the entire amount, Kiran presented all the bills of the hospital to the company but the insurance company made only additional payment of Rs 20,000. "Against claim of Rs 2 lakh, I was paid only Rs 90,000," said Mahajan.
Mahajan then moved the forum against the insurance company. Company claimed to have made the necessary payments and said in case of diabetes and hypertension-related diseases, full payments are made two years after hospitalization. But after scrutinizing all the documents, forum found company guilty of not providing money to the consumer under the policy. The forum directed the company to pay rest of the money with 8 % interest and Rs 4,000 for causing mental agony and litigation expenses.
Another consumer Sandep Bawniya moved the forum against oriental insurance company for cancelling his insurance claim and providing poor service. Sandeep Bawniya, purchased medi-claim under 'happy floater family' from the Oriental Insurance Company which was valid from August 2011 to August 2012. On February 2012, he got his father, who was suffering from heart-related problem, admitted to a city hospital and spent Rs 41, 925 on treatment. He asked the company to pay the claim amount, but the company denied. Even after several calls, company failed to reply. Following this, he moved the forum against the company and asked them to pay Rs 41, 925 with 9%interest and Rs 15,000 for harassing the consumer mentally. Since there was no reply from the respondent even after several notices issued, the contention of the complainant went unchallenged. Forum accepted the contention of the complainant as the documentary evidence. It directed the company to pay as per the company's clause with 8% interest and pay Rs 4,000 for mental and physical harassment.
No comments:
Post a Comment