The District Consumer Disputes Redressal Forum–ll, Hyderabad, here on January 21 directed United India Insurance Co. Ltd to pay Rs. 48,865 along with 9 per cent interest per annum on it from March 26, 2012 till date of realisation, to a customer for rejecting an insurance claim by her.
Vandana Gautam, a resident of Abids, knocked on the doors of the forum asking United India Insurance Co. Ltd to reimburse Rs.48,865, along with 12 per cent interest from March 26, 2012, till realization and another sum of Rs. Rs.50,000 for deficiency of service and mental agony on June 20, 2014.She claimed that the company had wrongly rejected her insurance claim.According to her complaint, Ms. Vandana said that she was covered by the group Mediclaim Insurance scheme provided by the Indian School of Business, her husband Vijay Gautam’s employer.
She wrote that under the ‘family floater’ scheme, the policy, which was valid from August 11, 2011 to August 10, 2012, came with a maximum (claim) limit of Rs.5 lakh.
Ms. Vandana said that she had been admitted at the Femina Women’s Hospital on March 26, 2012, after which she underwent a hysterolaproscopy the next day, and was discharged on March 28, 2012.
The bill for the treatment was Rs.48,865. When she submitted the same along with related documents for an insurance claim, United India Insurance Co. Ltd denied her claim saying that she was treated for infertility (according to records).
However, Ms. Vandana contended it, saying that the anaesthetist had wrongly written that her treatment was for infertility.
This was also corroborated by the doctor who treated her, and issued a document for the same as primary infertility.
“The anaesthetist inadvertently mentioned in the diagnostic column as primary infertility instead of diagnostic hysterolaproscopy for pelvic endometriosis,” read his statement.
The insurance company also alleged that Ms. Vandana “got the discharge summary altered to accommodate the claim”.
After going through all the documents, the forum ruled in favour of Ms. Vandana, and directed the insurance company to pay her Rs.48,865 along with interest at 9 per cent per annum, from March 26, 2012 till the date of payment along with costs of Rs.5,000.
Curated from Forum’s whack to insurance company