The New India Assurance Company Ltd has been pulled up and imposed a fine of Rs 25,000 for trying to mislead it by filing wrong terms and conditions about a policy on a compliant of denial of claim to a mediclaim policy holder.
The North West District Consumer Disputes Redressal Forum also ordered the insurance firm to pay Rs 23,000 to the policy holder for deducting Rs 3,000 from his claim of medical expenses on his mother's treatment.
"This forum is of the view that opposite parties (New India Assurance and its agent) are deficient in providing services to the complainant by not allowing the claim of the complainant in respect of room charges as per its terms and conditions...
"By filing copy of wrong terms and conditions with their (insurance firm's) written statement to substantiate their case was just to suppress the truth and misleading the forum," the bench presided by Rakesh Kapoor said.
It directed the insurance firm to refund to the policy holder the amount of Rs 3,000 deducted from his claim and to pay him Rs 20,000 as compensation and cost of litigation.
The forum's order came on the complaint of Delhi resident Parvesh Singhal who had bought a family mediclaim policy from New India Assurance for sum assured of Rs two lakh for a year from April 27, 2007 to April 26, 2008.
Singhal had alleged that the insurance firm had deducted Rs 3,000 from the amount claimed by him, as reimbursement of the medical expenses of his mother's treatment, without giving any reason.
In its defence, the insurance firm had contended before the forum that as per the terms and conditions of the policy, Singhal was entitled to receive only one percent of the sum assured towards per day rent of the room at the hospital.
The forum rejected the contention saying the insurance firm had filed wrong terms and conditions which were not applicable to Singhal's case.
It also directed the insurance firm to deposit the fine of Rs 25,000 in the Consumer Welfare Fund maintained at Delhi State Consumer Disputes Redressal Commission.