The District Consumer Claims Compensation Commission has directed the agency to settle the medical claim, finding that the insurance company had erred in partially covering the complainant’s medical bill. ₹40,000 and pay compensation ₹7,000.
The complainant, Manjit Singh Chahal of Khanna, underwent surgery in 2018 at Columbia Asia Hospital in Patiala. The operation was costly. ₹1,28,546, of which the insurer has paid ₹85,918 and the complainant had to pay approximately ₹42,000 from his pocket. The complainant contacted the insurer several times but to no avail.
Claiming the lack of services insurance, the complainant requested the Platform to settle its claim and pay him compensation. ₹1,50,000.
Seeking to dismiss the complaint, an insurance company attorney argued the complaint was premature and Chahal did not contact Park Mediclime Insurance for its claim disposition or deposit the receipt of the payment made by the complainant.
“If the complainant had denied the claim, the agency had to file a complaint. On receipt of a request for a cashless payment on September 10, 2018, permission to pay for the hospital ₹40,000 sanctioned by mail September 12, 2018. After the final bill ₹1,28,546 Received. ₹85,918 granted. However, due to the error of negligence, the total amount has been sanctioned ₹1,25,918 were unable to contact the hospital, resulting in a discrepancy from the complainant, ”the insurance company said.
The Commission in its order stated, “The complainant had to pay ₹40,000 from his own pocket as total sanction ₹1,25,918 were not addressed to the hospital, which clearly shows the lack of service on the part of the insurance company.
“The argument that the complainant must file a regular claim does not appear to be justifiable on the part of the insurer in view of the fact that it was admitted that he intended to pay the final bill. ₹1,25,918 had to be paid directly to the hospital, ”he said.