Insurance company directed to reimburse Coimbatore man’s medical claim

COIMBATORE: The district consumer disputes redressal commission has directed an insurance company to reimburse a customer’s medical claim of Rs 2 lakh, along with Rs 20,000 as compensation for mental agony and deficiency in service and Rs 5,000 towards the cost of proceedings.

According to official sources, A Prabhu of Sela Karichal in Sulur took a health insurance policy from a private insurance company for his mother, Valiamma, for a sum insured of Rs 2 lakh. His mother was diagnosed on June 18, 2024, with coronary artery disease and chronic obstructive pulmonary disease in a private hospital and was advised to undergo surgical intervention. She was discharged from the hospital on June 22, and the total medical bill amounted to Rs 2.38 lakh.

When Prabhu submitted a claim for reimbursement, he was made to run from pillar to post. But his efforts went in vain. No amount was reimbursed; nor did the company communicate any reason for repudiation or denial of the claim.

Left with no other option, he paid the entire bill amount of Rs 2.38 lakh to the hospital by borrowing the sum from outside sources at a high rate of interest. He later sent a legal notice to the insurance company. However, the company neither replied to the notice nor settled the matter.

Subsequently, Prabhu filed a petition before the Coimbatore district consumer disputes redressal commission. In their order, commission president R Thangavel and member P Marimuthu ruled in his favour.