Insurance firm directed to settle medical expenses of client, fined Rs 35K over deficiency in service

However, when the petitioner approached the company to claim the insurance money, they refused to release the amount citing errors in the discharge summary, and also sought the petitioner to submit some documents.
For representational purposes only
For representational purposes onlyFile photo

VIRUDHUNAGAR: The District Consumer Disputes Redressal Commission in Srivilliputhur recently directed an insurance company to settle the medical expenses of a Sivakasi resident, a health insurance policyholder of the firm, and slapped a fine of Rs 35,000 for deficiency in service.

The verdict was pronounced by President SJ Chakkkaravarthy and member M Muthulakshmi in a petition filed by J Madhanagopal against the general manager of the insurance company in Chennai and the branch manager of the company in Sivakasi.

According to the petition, Madhanagopal, along with his wife Yasodha and daughter Vishnupriya took a family health insurance policy from the aforesaid company for a period from July 19, 2022 to July 18, 2023. Owing to deterioration of health, Yasodha was admitted to a hospital in Sivakasi from July 14 to July 17, 2023. A total of Rs 41,836 was spent for the medical expenses.

However, when the petitioner approached the company to claim the insurance money, they refused to release the amount citing errors in the discharge summary, and also sought the petitioner to submit some documents.

Observing a a deficiency in service, the consumer's panel directed the respondents to settle the medical expense of Rs 41,836 as per the insurance policy, and further slapped a fine of Rs 25,000 for causing mental agony and material loss to the petitioner and Rs 10,000 as litigation expenses.

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