Chandigarh: Insurer fined

The District Consumer Disputes Redressal Commission has penalised a health insurance company for not reimbursing the full mediclaim to a Haryana-based woman.
Anita Jain from Jagadhri, Haryana, filed a complaint against CHD City Hospital, Chandigarh, and its five partners; and the Oriental Insurance Company Limited through its grievance officer in Chandigarh and directors in Panchkula, apart from Raksha Health Insurance ΤPA Pvt Ltd.
Anita had alleged that she and her husband, Ashok Kumar Jain (now deceased), had bought a ₹10 lakh health cover from Oriental Insurance Company Limited on June 19, 2020.
In March 2021, Ashok was admitted to CHD City Hospital after developing cough and fever. He was found Covid positive and succumbed to the virus.
The hospital billed her ₹5,35,231 for Ashok’s treatment. After she approached the insurer for reimbursement, she received only ₹3 lakh of the total amount. Thus, she filed a consumer complaint.
No one from the opposition party filed a reply, hence they were proceeded against ex parte.
The commission directed Oriental Insurance Company Limited to pay the balance amount of ₹2,34,018 to the complainant, along with interest at 9% per annum from the date of filing of this complaint.
The insurer was also told to pay ₹15,000 as compensation for causing mental agony and harassment, and ₹10,000 as cost of litigation.