Refusal to pass the claim
of Rs 27,200 of a senior citizen - United is fined Rs 50K
The decision of United India to stop the medical claim of Rs
27,200 of a senior citizen (80 years old) has proved costly for it with a
consumer forum directing it to pay a compensation of Rs 50,000 for the
harassment meted out to the policy holder.
Besides the fine, a District Consumer Disputes Redressal
Forum here has also directed United India Insurance Company to pay the claim
amount of Rs 27,200 with 9 per cent interest to complainant Jagan Nath Thapar.
Thapar had approached the forum, saying he had submitted all
the bills of his post-hospitalization expenses to the firm but it allegedly did
not pass his claim as the bills for the medicines were not produced.
"We are shocked by the attitude of the company, in such
a case. The company was free to get the cost of medicines assessed itself and
pay all other charges which are reasonably incurred by an old patient of 80
years," the forum presided by C K Chaturvedi said.
"We award higher damages for deficiency and harassment
and litigation to an old man. We award a sum of Rs 50,000 for these
heads," the forum said.
The forum observed that the insurance company had acted in a
"penny wise and pound foolish" manner by arbitrarily stopping a just
claim and instead was ready to pay a huge interest if it passed an order
against it.
"The company seems to be acting 'penny wise and pound
foolish', in arbitrarily stopping just claim, and is ready to a pay hefty
interest for delay, when the court make award after a few years," it said.
"It should mend itself and discipline its officers to
apply mind and heart to the jobs they are expected to do," the forum said.
Thapar had said he was allowed compensation and treatment
expenses under the policy by a March 2008 judgement of the consumer forum
during his stay in the hospital in 2006.
After being discharged from the hospital, the doctor had
prescribed him some medicines, physiotherapy and tests for a period of two
months on which he spent Rs 27,200, Thapar said.
The insurance company, however, did not contest Thapar's
petition and the forum proceeded against them ex-parte.
What we learn from this judgement is that one should be
persistent in follow up with the Insurance Company .There are good chances of
success. You will appreciate that judgement is ex-parte which means that United
knew that they are on weak footing therefore none (official or lawyer) appeared
on their behalf.
