A consumer forum here has asked an insurance firm to pay over Rs 80,000 to the family members of a man for "arbitrarily" declining his mediclaim "without application of mind".
A bench of New Delhi District Consumer Disputes Redressal Forum, presided by C K Chaturvedi, asked The New India Assurance Co Ltd to pay Rs 81,403 to the family members of one Iswar Prasad Goyal for denying the mediclaim, saying "it is a clear case of deficiencies/breach of contract".
"Opposite Party (firm) arbitrarily declined the claim without application of mind or supporting with medical observation by any expert or report of any medical officer except blow in the air to deprive complainant's right from his genuine claim," the forum said, adding it was a clear case of deficiencies/breach of contract and "unfair trade practice on the part of OP".
"OP is directed to refund Rs 51,403 in the name of LRs (legal representatives)... We also award Rs 30,000 as compensation for harassment and litigation expenses to the complainant as he has been struggling for justice from 2010 to 2014 unnecessarily," said the forum.
Iswar Prasad Goyal, now deceased, had taken a mediclaim policy from the firm. He was admitted to Vinayak Hospital, Model Town in March 2009 and later on shifted to Agrasen Hospital for treatment of cirrhosis of liver and later discharged, his family members told the forum.
He submitted a claim form along with all bills of both hospitals to the firm for reimbursement of expenses but it repudiated the claim on the ground that cirrhosis of liver had happened due to intake of alcohol, they said.
Thereafter, a complaint was filed seeking reimbursement of Rs 51,403, spent in both the hospitals, they said.
Notice was served to the firm but none appeared on its behalf and it was proceeded ex-parte.
