United India Insurance Pvt Ltd fined for not reimbursing mediclaim after sanction

AHMEDABAD: A consumer commission in Gandhinagar has imposed a fine of Rs 10,000 on an insurance company in a “bizarre” case of denying health insurance money to a senior citizen only because one of his bank accounts had been closed upon his retirement.

The Gandhinagar District Consumer Dispute Redressal Commission has ordered the United India Insurance Pvt Ltd to reimburse Rs 1.91 lakh claim with 9% interest to policy holder Ashwinbhai Shah, a resident of the state capital, for his wife’s knee replacement injury in 2017. The insurer has been also ordered to pay Rs 15,000 as compensation for causing mental harassment besides compensation of Rs 10,000 for deficiency in service and unfair trade practice. In this case, Shah’s wife underwent a knee replacement surgery in July-August 2017, and the retired bank employee claimed the expenditure incurred on treatment. The claim was sanctioned and the insurer transferred the amount through RTGS to Dena Bank’s Manekpur branch, where Shah used to work. But the amount was not received because the bank account had been closed upon Shah’s retirement in October 2016.

Shah immediately provided details of his new account in Gandhinagar branch, but the amount was not received. He made repeated representations, but did not receive the money. He sued the insurer finally. The insurance company argued that it was not a fault on its part because the account was closed.

The consumer court did not buy the insurer’s argument and said that it meted out disservice to senior citizen making him battle against the company unnecessarily for three years. It further said, “There is no fault on part of the insured because payment was not made even after second bank account details were provided… This is a bizarre case in which a senior citizen has been dragged into the litigation not for the fault of complainant but for the sheer carelessness and negligence on part of the insurance company.”

Source: The Times of India

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