Insurance firm told to pay mediclaim

According to the petition, S Chandra, a resident of Nandanam, was admitted for MRGFUS treatment at a private hospital on May 25, 2013. But the medical claim policy for Rs 1 lakh was not accepted in a said hospital and immediately, she informed the insurance firm executives who assured her that money would be reimbursed once she submits the claim form with medical bills, the petition claimed.

Chandra contended that she had submitted the claim form along with the medical bills for a sum of Rs 1,83,500 for reimbursement through TTK Health Care Service Private Limited. Even after repeated requests, the insurance firm has not stated anything about the status of the claim and caused great mental agony, Chandra claimed in her complaint.

Countering this, the insurance firm denied all the allegations and said that the claim form didn’t have the treatment date and also the manner of treatment. The firm contended that she had submitted the claim for reimbursement via third party administrator and there is no deficiency in service and the case was liable to be dismissed.

 Recording the submissions, M Mony, forum president and R Baskarkumaravel, forum member, ordered the insurance firm to pay the assured sum of Rs 1 lakh and to pay Rs 10,000 towards compensation for mental agony with the cost of Rs 5,000.