Consumer Forum orders New India Assurance Company to pay up claims
Consumer Forum orders New India Assurance Company to pay up claims without hassles
The District Consumer Forum came down heavily on the New India Assurance Company for not reimbursingu00a0 medical expenses in two separate cases. The Forum ruled that expenses incurred for an external device and for physiotherapy, should be reimbursed.
The decision was taken in the cases of Ajay Maheshwari (53) and Marzban Jamula. The court has asked the company to pay the balance amount at 9% interest, Rs 10,000 towards compensation for mental stress and Rs 5,000 for the cost of the complaint.
Case 1
Maheshwari was suffering from Obsessive Sleep Apnoea and was hospitalised for two days. On the advice of his doctor, he bought a CPAP Machine (Continuous Positive Airways Pressure Machine with Auto Tritating Feature) for Rs 84,000. While the insurance company paid for his hospital expenses, they refused to pay the cost of the machine. "I claimed the amount for the device in January 2004. But to my shock, they rejected my claimu00a0 in a one line answer stating 'Non-Medical Expenses/ Medicines, not payable'," said Maheshwari.
The forum, headed by Bharti Marfatia, held that the CPAP machine was a life-saving device, hence the insurance company should pay for it.
Case 2
In Jamula's case, the insurance company reimbursed his expenses for a 12-day hospital stay, but rejected claims for consultation, physiotherapy and professional charges. The forum held that as doctors would first diagnose the disease before starting any treatment, all related expenses are considered as medical expenses.
The chairman of the New India Assurance Company was unavailable for comment.
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