Insurance company told to release Rs 3L med claim, slapped Rs 30k fine in TN

The complainant underwent angioplasty in February 2023 and spent Rs 3,04,869 for the treatment. Following this, they claimed the insurance, but the company failed to reimburse the amount.
Image used for representational purpose.
Image used for representational purpose.

VIRUDHUNAGAR: The District Consumer Disputes Redressal Commission in Srivilliputhur directed an insurance company to release a medical insurance claim of Rs 3 lakh to a customer and pay a fine of Rs 30,000 for deficiency in service. The commission, comprising President SJ Chakkkaravarthy and member M Muthulakshmi, issued the verdict after hearing a petition filed by G Selvaraj of Rajapalayam against the general manager of the insurance company in Chennai and the branch manager in Sivakasi.

According to sources, Palaniammal, wife of the complainant, had taken an insurance policy covering both of their medical expenses up to a limit of Rs 3 lakh for one year, from March 18, 2022, to March 17, 2023. The complainant underwent angioplasty in February 2023 and spent Rs 3,04,869 for the treatment. Following this, they claimed the insurance, but the company failed to reimburse the amount.

The commission, which observed that the respondents' refusal of the complainant's claim amounts to a deficiency in service, directed the company to release the claim as per policy and pay a compensation of Rs 20,000 for the mental agony incurred by the complainant. The respondents were also asked to pay a sum of Rs 10,000 as litigation expenses within six weeks.

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