Thane Consumer Redressal Forum has ordered an insurance firm and a third party administrator (TPA) to jointly pay Rs 10,000 as compensation beside claim money to a man, observing that the rule to inform insurance firm and TPA within 24 hours of hospitalisation is “harsh.”
Forum president N D Kadam and Sneha Mhatre in their order delivered on Monday directed United India Insurance Company and TPA, Medsave Healthcare Ltd to jointly pay the claim amount and an additional of Rs 10,000 to Bhiwandi resident Ansari Hafij-ur-Rehman, towards his mental suffering.
The complainant told the forum that he had got his health policy of Rs 1,72,000 renewed for a period from September 2009 to August, 2010.
Rehman said he was unwell from July 23-28, 2010 and was admitted to a hospital for treatment of hypertension and diabetics type-2. Later on July 30, he again fell sick and was referred to Jupiter Hospital. The entire treatment cost him Rs 1.54 lakh.
Meanwhile, his family members informed the insurance firm and the TPA on July 23 only.
However, he was told next year in January by the company that his claim has been rejected on grounds that he did not inform within 24 hours of the hospitalisation.
Following the rejection, Rehman approached the forum and adduced all relevant documents.
The forum observed that the complainant duly apprised the firm within 24 hours and thereby rejected insurance firm’s claim.
“If an insured sufferers sudden illness and is admitted to hospital, then his relatives will first attend to his treatment. At that time it is necessary to take into account the mental situation of the relatives of the sick person. At that time the condition laid by the insurance companies that they should be intimated within 24 hours of the admission after getting the requisite documents is a harsh one,” the forum said.