Forum asks insurer to pay man Rs 15,000 mediclaim

Noida: The district consumer commission has asked Star Health Insurance to pay a Dankaur resident a medical insurance claim of Rs 14,716, with interest calculated at 6% per annum from the date of filing the complaint in April 2023 until payment is made.

On May 2, commission president Anil Kumar Pundir and member Anju Sharma ordered the insurance company to pay an additional Rs 2,000 for mental agony and litigation costs within 30 days of the judgment.

Bijendra Singh sought relief from the commission after his application to the insurance company for settling the claim went unanswered. Singh told the commission that he bought a Rs 5 lakh mediclaim policy with a yearlong validity on Oct 23, 2021.

In Sept next year, he was admitted to Sukhamal Dalchand Numberdar Hospital with high fever. He said he informed the insurance company about this and the company issued a claim number. He was treated at the hospital for three days. When he contacted the insurance company, they assured him that the expenses would be taken care of once he submitted the bills and diagnostic reports. During discharge, he settled the hospital bill.

After he submitted the documents, Singh alleged the insurance company stopped responding to him. “Following repeated attempts, the insurance company finally sent me a message stating that the claim failed. But when I tried contacting them to know the reason for rejection, they did not provide a satisfactory response. Such an action constitutes deficiency in service,” Singh told the commission.

Notices were sent to the insurance company, but there was no response. The commission then decided to proceed with the matter on Feb 27, 2025, in its absence. It noted, “The insurance company has committed a service deficiency by rejecting the claim, although Singh paid the entire premium on time. Therefore, Singh’s complaint is admissible.”
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