Yamunanagar: Insurance Firm told to Settle Consumer’s Medical Bill Claim

The Yamunanagar District Consumer Disputes Redressal Commission (DCDRC) has directed an insurance provider to reimburse a Yamunanagar resident’s medical bill claim of Rs 26650.

In order to fully compensate for the complaint, the insurance firm has also been granted a punitive damage award of Rs 10,000 by the DCDRC.

On February 20, the DCDRC’s president, Gulab Singh, together with members Sarvjeet Kaur and Jasvinder Singh, passed the order.

Rupak Gupta of the Jagadhri Workshop area obtained a health insurance policy from the insurance business called “family health optima insurance plan” for the period of February 17, 2023, to February 16, 2024, in accordance with the DCDRC’s directive.

The policy was a carryover from two previous policies that covered the dates February 17, 2021–February 16, 2022, and February 17, 2022–February 16, 2023.

The complaint was admitted to the hospital for four days, from March 3, 2023, to March 6, 2023, during the policy’s validity period, in order to address pneumothorax, or chest discomfort.

The complainant spent Rs 26,650 on medical care while in the hospital, and he filed a Rs 26,650 medi-claim with the opponent under the policy by providing all the necessary documentation.

However, the opponent rejected his claim, arguing that the complaint’s paperwork demonstrated that he was experiencing a number of anomalies and that the insured patient’s care was not visible.

In his complaint, the complainant claimed that the opponent had repudiated his claim, engaged in willful carelessness, violated service standards, and engaged in unfair trade practices. These actions allegedly caused the complainant mental anguish, harassment, and financial loss, all of which forced him to initiate the current complaint.