The South Mumbai district consumer forum has ordered the United India Insurance company to pay a compensation of Rs3lakh to one its retired employees for having reimbursed him a lesser amount of mediclaim. The forum, while asking the firm to pay the said amount, held that the firm had adopted unfair trade practice by deducting the insurance amount, thus resulting in deficiency in service.
The forum has asked the company to pay the amount with 6% interest from June 2011. It has also asked the firm to pay Rs8,000 as a compensatory amount for mental agony caused to the complainant.
In January 2011, Andheri resident Kirti Shah, an ex-employee of the company, was admitted to a private hospital for a heart condition. The hospital had first performed a CT angiography on him and later he had to undergo a coronary angioplasty. The total expense for the treatment was Rs3lakh. Shah, who had opted for a family medical policy from the company, sought
reimbursement of his expenses.
The company deducted Rs78,324 from the claimed amount and thus handed Shah a full and final payment of Rs2,29,253. When Shah asked for a valid reason for deducting the amount, the firm claimed that the hospital had charged excess amount. It said that the hospital had charged Shah ‘extra tariff package rates’ for stay at the hospital and this, said the company, was not in keeping with one of the clauses.
The forum, after going through medical bills and evidence produced by the complainant, held that as per the clause, there was no mention of such a deduction if a policy holder is over 70 years of
age. Thus, it said the firm was at fault in not reimbursing the amount.
The forum, in its order, observed: “The opposite party (firm) had adopted unfair trade practice which amounts to deficiency in service. As the firm deducted the amount from the complainant’s claim amount, the firm should repay Rs3lakh along with 6% interest from June 2011. Also the complainant was subjected to tremendous mental agony by the firm; hence the firm should pay Rs8,000 compensation. The firm should pay Rs 10,000 towards the complainant’s legal expenses.”
United India Insurance said that the hospital had charged its former employee Kirti Shah ‘extra tariff package rates’ for stay at the hospital and this was not in keeping with one of the clauses.