‘Insured sum to be paid even if hospital has closed down’: Vadodara Consumer Redressal Commission

VADODARA: Hearing a case against an insurer which, in 2017, had rejected a patient’s claim of Rs 1.56 lakh on the argument that the hospital had closed down since, president of Vadodara Consumer Dispute Redressal Commission (additional) I C Shah has ruled that the insurance firm has to pay the insured sum irrespective of the hospital’s present existence.
The consumer forum was hearing the case of Jugal Mehta, a resident of Gotri Road, who had sued the National Insurance Company Ltd (NICL) in 2017 after it rejected his claim.
In his petition, Mehta said that he had bought a health policy from NICL for one year in May 2016. Later, he was diagnosed with pleural effusion with multiple septation with atelectasis and was admitted to the hospital in October 2016 for nine days.
He then claimed Rs 1.56 lakh from NICL towards the medical treatment expenses he had incurred.
The insurance firm rejected his claim and informed Mehta about it in August 2017, stating that the hospital in which Mehta claimed to have got treatment had closed down and there is no evidence that the complainant got any treatment or paid the bills.
Mehta, however, said that he had submitted the necessary documents of his treatment and along with the discharge summary signed by the doctor. He argued that the insurance firm didn’t get any affidavit or statement from the doctor regarding the treatment. Mehta has also produced the medical report of his condition from a diagnostic centre.
But the insurance firm argued that the pathology report is fake and added that when it inquired about the treatment in the hospital in 2019, it had already closed down. Mehta said that the hospital was given to some other doctor and even if the hospital closed down, it doesn’t mean that he wasn’t treated there.
The court accepted Mehta’s arguments and ordered the insurance firm to pay him Rs 1.56 lakh with nine per cent interest from the day the complaint was filed in the consumer forum. The firm has also been ordered to pay Rs 5,000 towards mental agony and another Rs 5,000 towards expenses to Mehta.