THIRUVANANTHAPURAM: An 80-year-old woman who was denied benefits under the Medisep got relief from the State Consumer Disputes Redressal Commission. The woman, hailing from Malappuram, was a retired government employee covered under the Medisep health insurance programme for government employees and pensioners.
The complainant said she was admitted to a private hospital in Kozhikode from October 24, 2023, to October 31, 2023, where she incurred nearly Rs 1,30,000 as treatment expenses. At the time of discharge, the hospital authorities asked her to pay the entire amount and get it reimbursed under Medisep, which she did.
However, the insurance company, Oriental Insurance Company Limited (OICL), paid only Rs 38,100. Based on her complaint, the Malappuram District Consumer Disputes Redressal Commission directed the insurance company to pay the balance amount to the complainant.
The appeal filed by OICL was heard by the SCDRC bench, comprising its president Justice B Sudheendra Kumar, judicial member Ajith Kumar D and member K R Radhakrishnan.
The bill submitted by the hospital showed that the total amount paid by the complainant was Rs 1,25,006. Of this Rs 38,100 was refunded. The state commission affirmed the district commission’s finding that there was deficiency in service by the OICL. It directed the firm to pay the balance amount of Rs 86,906. It also affirmed the costs awarded by the district commission (Rs 10,000).