The South Mumbai's district consumer dispute redressal forum thus asked the firm to reimburse for the medical bills to the complainant along with 9% interest on the amount from the year 2013.
The consumer forum recently pulled up National Insurance company for wrongly repudiating the claim of a South Mumbai (SoBo) resident, claiming that the ailment suffered by the complainant was due to previous eight child deliveries and that such an ailment did not fall under the ambit of seeking for a medical re-reimbursement.
The South Mumbai's district consumer dispute redressal forum thus asked the firm to reimburse for the medical bills to the complainant along with 9% interest on the amount from the year 2013. The forum, also asked the firm to pay an additional amount of Rs5000 and Rs3000 as compensatory amount towards the mental agony and litigation charges respectively.
The case dates back to the year 2012, when the SoBo resident had purchased the insurance policy, which gave her a cover of Rs5 lakhs, had sought treatment of uterine prolapse with cystorectocele from Breach Candy hospital. She was discharged from the hospital on July 28 in 2012. She had thus informed about the ailments and the medical bills immediately to the insurance firm. The complainant also had the letter issued by her gynecologist, explaining about the medical condition and the need for the operation. The claim, however, was repudiated by the insurance firm. The complainant had then issued a legal notice to the agency seeking for the compensation amount, but the firm did not pay heed to it.
The forum after going through the evidence, asked the firm to file the reply, to which, the firm replied: "The situation is nothing but pertaining to the pregnancy and childbirth. After considering the fact and opinion of the doctor and terms and conditions of the policy, it was rightly repudiated by the insurance agent."
The forum after going through the evidence, maintained that no where it was a pregnancy issue, but the insurance company had no clause, which said that it would not reimburse the expense for pre or post pregnancy related ailments.
The forum held: "It is not material whether the said ailment was caused due to the previous eight deliveries or due to any other reasons. However, it is clear that on the day of admission of the complainant in the said hospital, she was suffering from ailment and she had underwent for a treatment. From the evidence available on record, we find that the insurance firm have wrongly repudiated the claim of the complainant and hence, she is entitled for the reimbursement of the medical expense of Rs 2,56,362."
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
 "consumer-Affairs")
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
)
){kind=small}
){kind=small}
)
)
)
)
)
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}