In a recent ruling, the Srivilliputhur District Consumer Disputes Redressal Commission mandated an insurance company to reimburse the medical expenditures of a Sivakasi resident, who holds a health insurance policy with the firm. Additionally, the commission imposed a penalty of Rs 35,000 on grounds of service inadequacy.
The decision was delivered by President SJ Chakkkaravarthy and member M Muthulakshmi following a petition submitted by J Madhanagopal against the general manager of the insurance company in Chennai and the branch manager in Sivakasi.
According to the filed petition, Madhanagopal, accompanied by his wife Yasodha and daughter Vishnupriya, procured a family health insurance policy from the aforementioned company spanning from July 19, 2022, to July 18, 2023. Due to Yasodha’s deteriorating health condition, she was admitted to a Sivakasi hospital from July 14 to July 17, 2023, incurring total medical expenses amounting to Rs 41,836.
Upon the petitioner’s attempt to claim the insurance coverage, the company declined payment, citing discrepancies in the discharge summary and requested additional documentation.
Noting the service deficiency, the consumer panel instructed the respondents to honor the insurance policy by settling the Rs 41,836 medical expense. Furthermore, a fine of Rs 25,000 was imposed for inflicting mental distress and financial loss upon the petitioner, along with an additional Rs 10,000 to cover litigation expenses.
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