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Insurance firm ordered to reimburse consumer's medical bills
Updated : Mar 15, 2014, 06:00 AM IST
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The Thane district consumer forum has directed Cholamandalum General Insurance Company to pay Rs 4,98,444 as compensation to one of its consumer after the firm refused to reimburse her medical bills.
The money has to be paid with six per cent interest with effect from May 2009. The company has also been asked to pay Rs 20,000 towards the consumer's other expenses.
According to Shilpa Marathe, the complainant, she bought a 'Travel Health' policy, valid from December 25, 2007 to April 4, 2008, from the firm. As per the policy norms, the firm was to cover medical expenses worth Rs 49 lakh.
On December 30, 2007 Marathe left for the US to be with her daughter.
"Till February 2008, Marathe was in proper health. But on March 9, she realised her legs were turning numb, and her heartbeats had increased. Her daughter immediately got her admitted in a nearby hospital. She was there for a day and was given primary treatment," says the consumer order copy.
A few days later, Marathe returned to India and started seeking medical treatment at Jupiter Hospital, Thane.
In the meantime, she had approached the insurance firm seeking reimbursement for the medical bills she had to pay while in the US. But the firm rejected her claim saying the health problems she had developed while in the US was because she had hypertension and diabetes before, and that according to policy norms, "health issues caused due to pre-existing diseases were not covered" under the company's policy.
Marathe then approached the forum and lodged a complaint. The company was asked to file a reply, but its contentions were rejected and it was asked to reimburse her medical bills.
