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New India Assurance to pay Rs. 60,000 for rejecting mediclaim

The public sector general insurer has failed to reimburse expenses worth Rs. 45,252 of Shiv Kumar Gupta on his son's hospitalisation

May 24, 2012 12:35 IST | India Infoline News Service
The Central District Consumer Disputes Redressal Forum has ordered New India Assurance to pay over Rs. 60,000 to one of its mediclaim policyholders based in North Delhi.
The public sector general insurer has failed to reimburse expenses worth Rs. 45,252 of Shiv Kumar Gupta on his son's hospitalisation.
Apart from ordering to reimburse Mr. Gupta's expenses on his son's hospitalisation, the Forum has also asked the insurer to pay him Rs. 10,000 as compensation against harassment and Rs. 5,000 as litigation cost.
The Forum said that New India Assurance had received the policy premium from Mr. Gupta and when the benefits were required to be extended to the complainant then the insurance company closed the claim without any valid reason.
Mr. Gupta had purchased a mediclaim policy for himself and his family members from New India Assurance for period from 16 April 2010 to 14 April 2011.
According to Mr. Gupta, he had informed the third party administrator (TPA) of the insurance company on 7 December 2010, regarding his son's hospitalisation and had submitted his claim of Rs. 45,252 with requisite documents on 10 December 2010. He was assured by the insurer that his claim was being processed.
New India Assurance said it had closed Mr. Gupta’s claim as he had not provided the doctor's prescription slip and IPD paper despite reminders. The insurance company's defence was rejected by the Forum, which held that the requisite papers were provided by Gupta and as the insurance company and its TPA failed to prove they had sent reminders to him, closing of the claim was not justified.

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