CHENNAI: After a health insurance firm failed to provide the necessary claim to a patient, a city consumer forum directed the firm to provide a compensation of Rs 34,140 to a city resident.
Easwara Gupta, a resident of Parrys, underwent an angiogram at a private hospital in 2014 and was never provided with the claim by the insurance company, thus submitting a complaint at the forum.
According to the petition submitted by Easwara Gupta to the forum, she has been a health insurance policyholder for the past 20 years and in June 2013, an angiogram was conducted at a private hospital. She was diagnosed for the history of diabetes for 20 years and hypertension for 15 years through which an angiogram report was based. This was submitted at the forum. Merely because there was a history of diabetes and hypertension mentioned in the discharge summary, the
claim was denied by the New India Assurance Co Ltd and Raksha TPA Pvt Ltd. Easwara Gupta thus submitted a petition at the District Consumer Disputes Redressal Forum at Chennai South, seeking compensation of Rs 1,14,140.
Based on the documents submitted, the forum presided by M Mony of the District Consumer Disputes Redressal Forum Chennai (South), observed that the insurance firms denying claims proves the negligence and deficiency in service. The forum directed the insurance firms to provide a compensation of Rs 34,140 to Eswara Gupta for the mental agony and the amount expended towards the medical treatment.