HYDERABAD: During times as tough as fighting breast cancer, depending on health insurance proved futile for a city-based woman. However, a district consumer forum’s ruling, which ordered full reimbursement of her treatment costs worth 2.77 lakh along with additional compensation of Rs 1.1 lakh, came as a strict lesson for all the health insurance firms.
In the said case, a retired banker from Bollarum had complained against the National Insurance Company for not reimbursing the insurance claim of his wife, who was undergoing treatment for breast cancer. As per the judgment, T Nagaraja Prasad’s wife was diagnosed with breast cancer after a lump was found in her left breast in June 2014.
The doctors were able to cure the woman’s cancer, but with chemotherapy included in the treatment, the costs touched over Rs 2.5 lakh. Prasad hoped to claim cashless medical insurance for the expenses incurred. However, the said insurance firm declined the request on the pretext that it did not receive a claim to enable reimbursement of expenses.
As per the company’s submission, Prasad signed up for the Varishta Mediclaim policy to be covered under medical insurance. This, by default, included his wife also as a claimant.
Prasad filed multiple claims but none of them were paid any heed since the insurance company remained adamant on its stance. The insurance firm also held that even if the claim was demanded for critical illness, a medical expert needed to evaluate the extent of the sickness and approve of it. Pleading this as the reason for not releasing the claim, the insurance firm held that the complainant was not eligible for the insurance claim.
The Hyderabad Consumer Forum, in its order, held the insurance firm at fault. It stated that there was a deficiency in the services on part of the insurance firm as it did not reimburse the claim as requested. The forum asked the Rs 2.77 lakh to be reimbursed with interest, apart from Rs 1 lakh for the inconvenience, and Rs 10,000 for legal charge