For, the state consumer commission has directed the United India Insurance Company Limited to pay Rs95,000 as medical reimbursement to the Sion resident in 45 days.
Justice was delayed, but not denied. More than 13 years after having filed a complaint with the consumer district forum that the insurance company she had drawn up a mediclaim policy with refused to reimburse her hospital expenses of Rs 1,24,945 after a knee replacement surgery, Manjula Katakia can finally relax. For, the state consumer commission has directed the United India Insurance Company Limited to pay Rs95,000 as medical reimbursement to the Sion resident in 45 days.
Jaswantrai Katakia and Manjula Katakia had taken a mediclaim policy with the company for Rs85,000 and Rs 95,000, respectively, in April 1991. On October 22, 1997, Manjula underwent a knee replacement surgery at the Bhatia General Hospital and filed a claim for reimbursement of the hospital expenses of Rs1,24,945.
But, the company refused her claim on the grounds that it was not informed of a pre-existing condition of joint pain, which, it claimed, is not covered by it, at the time the policy was taken.
Manjula then approached the district consumer forum in 1998, which turned down her plea. Thereafter, in March 2001, she sought redress from the state consumer commission.
The commission observed that Manjula had been renewing her mediclaim policy from time to time, except for a brief period between April 24, 1995 and June 1, 1995. It added that at the time of her admission to hospital, it was recorded in the hospital record that she had been suffering with pain in the right knee for five years. The insurance firm tried to shift blame on Manjula with the help of this hospital record.
The commission said since Manjula has a policy cover of Rs95,000, the company can limit her reimbursement claim to that amount.
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