A district consumer forum has
ordered New India Assurance Co. Ltd. in May 2012 to pay a policy-holder Rs.60,
000 for refusing to reimburse expenses incurred on hospitalization.
Shiv Kumar Gupta had spent Rs.45,
252 on his son’s hospital stay in 2010. The district consumer disputes
redressal forum has ordered the company to reimburse the amount and also pay
Rs.10, 000 as compensation for “harassment’ and “mental agony” and Rs.5, 000 as
litigation cost.
The insurance company refused to
pay claim by taking stand that Gupta had not provided all documents. Gupta
informed the third party administrator of the company of his son’s
hospitalization on December 7, 2010 and had submitted all the documents. He was
told his claim was being processed. The company later rejected it arguing that
doctor’s prescription slip and IPD paper were missing.
“Despite the fact that the
insurance company has received the policy premium when the benefits were
required to be extended to the complaint / family members it closed the claim
without valid reason,” said the forum. Therefore judgement was passed for
payment of Rs.60, 000
The Question before us is
“Should the officer of claim
department or the branch manager be asked to pay penalty of Rs.15, 000 out of
his salary?
Why should the company be penalized for payment of Rs.15,
000?
Comments are invited.
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