92-yr-old Chandigarh man wins legal fight against wrongly rejected mediclaim

Wrongly rejecting a 92-year-old man’s medical claim has cost an insurance firm dear. The 92-year-old alleged that despite the fact that the claim was fully covered as per the terms and conditions of the policy, the company wrongly repudiated it, which amounted to deficiency in service and unfair trade practice. Holding New India Assurance Co. Limited, Chandigarh, guilty of unfair trade practice, the District Consumer Disputes Redressal Commission-1 has directed the firm to settle the patient’s hospital bill worth ₹29,000 with interest at 9% per annum from the date of repudiation of the claim, March 15, 2022, till realisation of the same. Ram alleged that despite the fact that the claim was fully covered as per the terms and conditions of the policy, the company wrongly repudiated it, which amounted to deficiency in service and unfair trade practice. But after perusing the policy, the commission observed, “It is safe to hold that the case of the complainant is fully covered under the subject policy, especially as no insurance company can decide the line of treatment to be given to a patient, rather it is only the doctors who can decide about the treatment and also whether the patient was required to be admitted in the hospital or not.” It added, “Not only this, the opinion of the doctor who treated the patient is more truthful than the TPA’s opinion that is based on examination of the case papers.” Allowing the nonagenarian patient’s claim, the commission directed the insurer to reimburse his hospital bill.