Insurance staffer to pay for goof-up in consumer’s form

MUMBAI: A bungling employee will have to shell out the compensation amount to be paid to a woman for listing her sex as male in her policy form.
The South Mumbai District Consumer Disputes Redressal Forum has directed New India Assurance Company to hold an inquiry and find the defaulting employee whose mistake caused Worli resident Ria Alimchandani (23) severe mental agony.
The faux pas saw Ria’s 66-year-old father run from pillar to post to get the insurance company to foot his daughter’s medical bills after she underwent an emergency appendix operation. The company will pay Ria a compensation of Rs 10,000 and Rs 5,000 as the cost of litigation.
Ria had submitted her photographs with her policy form and listed her sex as female. The forum comprising president S B Dhumal and member SS Patil said the word Ms before Ria’s name on the policy form clearly showed that she is a female. “Still, the opposite party marked the insured as male. This is nothing but sheer negligence,” the forum said. Ria was represented in the forum by her father, Rajan.
On May 20, 2009, Ria, who had a medical insurance cover of Rs 2 lakh, was admitted to a hospital at Marine Lines with Acute Appendicitis. As Ria had opted for a cashless insurance cover, the hospital asked her to submit a copy of her policy. The hospital submitted a pre-authorization request to her insurance company’s company’s Third Party Agent (TPA), saying the total estimated cost of the operation and hospitalization would be Rs 65,000.
The operation was scheduled for May 21. Around 3pm that day, the TPA told the hospital that pre-authorization could not be sanctioned as Ria was marked as male in the policy. Rajan then approached the insurance company’s office where the development officer contacted the Mumbai TPA and informed them about the error, following which a fresh endorsement was sent.
On May 22, the TPA told the hospital that Rs 40,000 has been sanctioned for Ria’s treatment. The TPA had still labelled her as male despite being provided with correct information. On May 23, Ria was given a final bill of Rs 81,575 by the hospital. On May 24, the TPA increased the sanctioned amount to Rs 66,000 after Rajan repeatedly called them up.
The insurance company denied the allegation of unfair trade practice, but the forum held it guilty of deficiency in service.