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Consumer forum pulls up National Insurance company for wrongly repudiating medical claim

The forum has ordered the firm to pay Rs 1.40 lakh towards the reimbursement of the expenses along with nine percent interest rate from 2010

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The South Mumbai district consumer redressal forum pulled up the National Insurance company for wrongly repudiating the insurance claim amount of one of its consumer who had undergone a knee surgery. The forum has ordered the firm to pay back the medical reimbursement amount, Rs 1.40 lakhs along with nine percent interest rate from 2010. The forum also asked the firm to pay an additional amount of Rs 20,000 towards complainant's mental agony.

Ramrai Shanbaug, a Dahisar resident had purchased a medi-claim policy of Rs 3 lakhs from the insurance firm in January 2010. 

Ramrai, in the month of May 2010, had undergone a knee replacement surgery from Lilavati hospital and immediately had approached the insurance firm seeking reimbursement of his medical bills.

The insurance firm however repudiated the claim without giving any proper reasoning. The repudiation letter came much later , which restricted the complainant from seeking money from elsewhere. Before approaching the forum,the complainant had approached the insurance ombudsman, which had asked the firm to pay one lakh to the complainant.

The forum after going through the evidence held, “The insurance firm had received its premium regularly, the Complainant was not informed regarding his repudiation in proper time so he would have managed his claim.”

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