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Business

Med policy holders can seek interest for payment delay’ Maha Consumer Panel Asks Insurance Co To Pay Interest To Woman

December 31, 2018 06:40 AM

COURTESY  TOI DEC 31

Med policy holders can seek interest for payment delay’
Maha Consumer Panel Asks Insurance Co To Pay Interest To Woman
Rebecca.Samervel@timesgroup.com

Mumbai:

In a significant order benefitting mediclaim policyholders, Maharashtra consumer commission has held that incase there is a delay in receiving the reimbursement amount, one can claim interest on it. Ruling in favour of a woman who was reimbursed around Rs 1.7 lakh spent on an ovarian surgery almost three years after her claim, the commission said that she was entitled to 9% interest on the amount.


While New India Assurance Co Ltd had initially rejected her claim, she finally received the money in 2013 after an insurance ombudsman ruled in her favour.

Setting aside a district forum order, the Maharashtra State Consumer Disputes Redressal Commission said that it had not considered all the facts in a proper manner and wrongly came to the conclusion that the complainant had accepted the amount towards the full and final satisfaction of her claim and hence, was not entitled to get interest on that amount, along with costs and compensation.

“Opponent (New India Assurance Co Ltd) has not produced any document on record to show that complainant had received the amount towards full and final satisfaction of her claim, thus waiving her right to get interest on that amount along with costs and compensation. As she has received this amount after about three years, she is entitled to get interest on that amount,” the state consumer commission said.

The commission also ordered New India Assurance Co Ltd to pay her Rs 30,000 as compensation and costs of the complaint. The woman submitted an appeal before the state commission in 2017 after a district forum rejected her complaint in December 2016. She said that she was admitted to the hospital between April 26 and 30, 2011, and underwent ovarian surgery. She said after her claim was rejected on October 15, 2013, an insurance ombudsman ordered the insurance company to pay her the amount. In December 2013, she received the cheque from the company. She encashed the cheque.

Then, in February 2014, she gave a letter to the insurance company alleging that as her claim was given after three years, she is entitled to get interest on the amount of her claim, along with costs and compensation. When the insurance company refused this, she filed a consumer complaint.

 

 
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