Medical Insurance Co will have to pay interest for mediclaim payout delay: Maharashtra Consumer Forum

Mumbai: Medical insurance is considered a form of long-term savings for citizens and enables them to pay for health checkups, emergency medical costs and long-term treatment. However, when firms fail to settle the claim in time the policy loses its worth. One such case was raised before the Maharashtra State Consumer Disputes Redressal Commission, acting on which the Commission ruled that mediclaim policy holders can claim interest if there is a delay in receiving reimbursement.

The consumer panel's bench comprising president A P Bhangale and member D R Shirasao was hearing a plea filed by a woman seeking interest on Rs 1.67 lakh reimbursement received by her for an ovarian surgery almost three years after filing the claim.

In the order passed recently, the commission held that the woman was entitled to nine per cent interest on the amount.

According to the consumer panel order, the woman had availed medical insurance from New India Assurance Co Ltd. During the subsistence of the insurance policy, she underwent an ovarian cystectomy in April 2011. The Mediclaim Policy available through this Mumbai based public firm allows any Indian between 5-80 years to be insured as on March 31, 2007. This policy provides for cashless hospitalization in India for the treatment of any illness, disease or accidental injury suffered during the policy period. The payment of claims is made through third party administrators who have been empanelled by the company.

After discharge, she made a claim for hospitalisation charges which the insurance company repudiated.

The woman then approached the insurance ombudsman, who in October 2013 directed the insurance company to settle the claim of the woman.

Thereafter, the company paid her the claimed amount of Rs 1.67 lakh.

The woman, after encashing the amount, wrote a letter to the company seeking interest on the reimbursement due to delay.

When the company refused to pay the interest amount, she filed a consumer complaint.

The state consumer panel in its order noted that the insurance ombudsman had only directed the insurance company to give the claim of the opponent.

"There is no reference in respect of giving interest on the amount of claim and costs and compensation to the complainant," the panel said.

"The opponent (insurance company) has not produced any document on record to show that the complainant had received the amount of Rs 1,67,152 towards full and final satisfaction of her claim waiving her right to get interest on that amount along with costs and compensation," the order said.

The panel held that as the woman received the mediclaim amount after around three years, she is entitled to get interest on it.

"She (complainant) was also required to approach the insurance ombudsman for getting that claim from the opponent and hence, she is entitled to get compensation along with costs of litigation," the panel held.

The panel ordered the insurance company to pay the woman interest at the rate of nine per cent from April 2011 to December 2013, adding that this amount will have to be paid within a period of two months.

"The opponent shall also pay a sum of Rs 25,000 as compensation to the woman and Rs 5,000 towards litigation cost," the panel ordered.

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