The forum have asked the firm to pay back the medical expenses with nine per cent interest rate from the time the claim was repudiated, which is December 2015.
The Consumer forum has pulled up an insurance firm after it repudiated a medical bill of one of its complainant on the grounds that the patient who was suffering with Dengue was unnecessarily admitted in the hospital, when he could have been easily treated in an Out Patient Department (OPD). The forum have thus asked the firm to pay back the medical expense of Rs 40,000 which the patient incurred for treatment, along with an additional amount of Rs 10,000 towards the mental agony of the family. The forum have asked the firm to pay back the medical expenses with nine per cent interest rate from the time the claim was repudiated, which is December 2015.
The forum held that the doctor who was treating the patient had advised for his hospitalisation and thus it was necessary for the complainant to get their child admitted in the hospital. The forum held that there was a deficiency of services on the part of the insurance firm and the same has been proved and so it is mandatory for the insurance firm to compensate the complainant.
The case was filed by a Chira Bazaar resident, Samir Jain, against the Apollo Munich Health Insurance Company. According to Jain, he had purchased a policy from the firm which had provided a cover for his wife and his two children. In September 2015, Jain's 11 year old son was detected with Dengue and the doctors asked Jain to get his son admitted in the hospital. The total expense of the medical treatment along with the hospital bills came up to Rs 40,000 and Jain filed a medical claim. The insurance firm after going through the claim papers said that the treatment of Dengue could have been done in an OPD and did not require a hospitalization and thus repudiated the claim. Aggrieved by the same Jain had approached the forum and filed a complaint against the insurance firm.
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 "Medical Bill")
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