Ref. : ER/PR/th-dg/anjana.32
On a case filed by Consumer Education & Research Society (CERS)
along with Jitendra S. Shah and his wife, Anjana, Ahmedabad, the
Consumer Disputes Redressal Forum, Ahmedabad City, held New India
Assurance responsible for deficiency in service.
The Forum termed it “shameful” that the company had failed
to sanction a negligible claim amount of Rs. 10,718 against a hospitalisation
and domiciliary hospitalisation benefit policy. The company had
also failed to utilise an opportunity to provide better service
to the complainant, the Forum maintained.
Anjana had sustained multiple injuries in an accident on 9 March
2004, when she was admitted to hospital. During her six days’
stay there up to 14 March 2004, she was given six injections and
other medicines every day. The family had to incur a considerable
expenditure on her treatment.
In response to the couple’s reimbursement claim of Rs. 10,718,
New India Assurance sent a voucher for Rs. 6717. They returned the
voucher, justifying the claim of Rs. 10,718, and approached CERS
for help.
CERS sent a legal notice to New India Assurance. As there was no
response, CERS took up the matter with the Consumer Disputes Redressal
Forum, Ahmedabad.
The Forum observed that the complainants had proven their case
by cogent evidence and established the company’s deficiency
in service. Interpreting the Mediclaim Scheme in its right perspective
and taking the public sector insurance company as State, the Forum
said that it is not a subject of mere private concern of the contracting
parties, but a national concern as reflected in the norms of the
National Health Policy.
Therefore, it directed New India Assurance to pay Anjana Rs. 10,718
with 9 per cent interest from 9 March 2004 till payment, Rs. 2,000
towards mental agony, and Rs. 2,000 towards cost before 6 September
2006. It also ordered the company to pay Rs. 5,000 to CERS towards
cost.
Mr. U. M. Raval presided over the Forum, with Mr. Bharatbhai H.
Joshi as Member. Mr. H.P. Motiramani was the advocate for the complainants
and Mr. A.O. Chudgar for New India Assurance.
Date : 30/08/2006
Pritee Shah
Place: Ahmedabad
Editor
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