Reliance General Insurance Co Ltd has been ordered by a consumer forum here to pay over Rs 4.11 lakh to a policy holder for first denying him the cashless hospitalisation facility and then avoiding to reimburse his expenses on treatment.
Case # CC/840/10
Shri Anil Kumar Gupta
M/s. Reliance General Insurance Co. Ltd Dated: 03/09/2012 – New Delhi District Consumer Forum
The complainant had purchased a cashless mediclaim policy covering period from 16.6.2009 to 15.6.2010 from OP through his TPA. TPA was already exparte. The complainant had suddenly some chest pain on 10.10.2009 so he immediately contacted Heart Institute and he was advised to for hospitalization. He had a cashless mediclaim card and hospital authority immediately TPA for approval through mails/Fax on 13.10.2009 at 3:12 p.m. Simultaneously Dr. Praveen Kumar had also issued a medical history and disclosed in his letter that the complainant has no history of similar kind of episodes on 14.10.2009 at 3:58 p.m. but inspite of the above facts OP declined his cashless facility and the complainant had to bear himself to borrow money from various sources to save his life. The total amount complainant spent on hospitalization and operation was Rs.4,40,387/- and supportive documents are already on record. Further the complainant filed the claim and it was also repudiated on the ground of pre-existing without any evidence rather breach of contract law as doctor had already explained in his medical history that there is no past such history of diseases.
We have gone through the contents of OP para-4 in which OP has taken a plea that Escorts Hospital has been manipulated the history which clearly indicates the malafide intention and harassing attitude of OP to torcher the consumers arbitrarily without applying of mind and consciousness of justice. It has also been noticed that OP has deliberately avoided to make the payment to complainant from day one when he had contacted TPA for cashless facility which is totally unlawful Act for the consumer.
OP is directed to make the payment Rs.3,61,945/- as per bills including with 9% interest from the date of claim to till realization. We also award Rs.50,000/- to the complainant as harassment and litigation cost.