The New Delhi District Consumer Disputes Redressal Forum held the insurance firm deficient in providing service to its customer, T R Mahajan, for not settling his medical bills by treating it as 'no claim', "without any proper reasoning".
"The claim was not settled and treated as 'no claim' and later on repudiated without any proper reasoning. There is deficiency on the part of opposite party (National Insurance Co Ltd).
"As such, holding opposite party guilty of deficiency in service, we direct it to pay Rs 15,072 (the medical expenses). We further, award Rs 10,000 as compensation for harassment and litigation cost," the bench presided by C K Chaturvedi said.
The order of the forum came on the plea of T R Mahajan, a resident of Punjabi Bagh here, who had said that the insurance firm had arbitrarily rejected his claim for reimbursement of the expenses, Rs 15,072, incurred on his treatment.
Mahajan in his plea had said he had obtained a mediclaim policy from National Insurance Co Ltd for the period from January 20, 2001 to October 19, 2002.
He had added that he was hospitalised on July 1, 2002 due to sudden breathlessness and had undergone various clinical tests and was discharged a day later when his condition had stabilized.
The National Insurance Co Ltd in its defence had contended that Mahajan's complaint was barred by time, but this argument was rejected by the forum which said his plea was filed two years after the claim was denied by the insurance firm.