Picture of District Consumer Court Chaibasa.
Jagran correspondent, Chaibasa. The Consumer Commission has held National Insurance Company Limited and its TPA agency Safeway Insurance TPA Private Limited guilty of rejecting mediclaim claims. The Commission has ordered the consumer to pay Rs 2 lakh 75 thousand.
This amount will be given towards mediclaim, mental anguish and litigation expenses. The Commission has clarified that if payment is not made within 45 days of receiving the copy of the order, 9 percent annual interest will also have to be paid on the amount due.
The complainant in the case is Rajesh Prasad Sao, a resident of Chhota Neemdih of Chaibasa, who had taken the New National Family Mediclaim Insurance Policy. This policy was valid from 27 April 2022 to 26 April 2023.
Due to serious neck and back disease during the insurance period, he had to be admitted to Sir Ganga Ram Hospital, New Delhi from 25 to 29 October 2022. During this period, a total of Rs 2 lakh 45 thousand 965 was spent on his treatment.
The complainant submitted a mediclaim claim as per rules, but the insurance company rejected the claim saying that the illness fell under the waiting period of the policy.
During the hearing of the case, the Consumer Commission found that the insurance company failed to prove that the terms of the policy were duly made available to the complainant.
The Commission also held that the treatment took place within the insurance period and the policy was in continuing effect. Rejecting a claim merely by citing rules without properly communicating the policy terms is a serious deficiency in service.
On this basis, the Commission ordered the insurance company to pay mediclaim amount of Rs 2,45,965, Rs 20 thousand for mental agony and Rs 10 thousand as litigation expenses.