District consumer disputes redressal forum has directed the Oriental Insurance Company Limited to pay ₹30,851 to a Kapurthala man for the cost incurred on his medical treatment along with interest 12% per annum from July 2019 till realisation.
The forum also directed the insurance company to pay ₹17, 000 as compensation and litigation expenses for causing mental agony to the complainant.
Complainant Surinder Pal Singh, a resident of Moti Bagh Colony, Kapurthala, told the forum that he got a PNB-oriental royal mediclaim policy on December 1, 2017, and paid its premium each year in January whose last premium is due on January 31, 2020.
The complainant told the forum that he suffered with CAD (Cardio Artery Disease) in May 2017 and was hospitalised on July 27 to July 31, 2018, at a private hospital and had paid ₹30,851 to the hospital. However, the insurance company denied to pay the claims despite submitting all bills and required documents on time.
Upon the notice, representatives of the company said that at the time of purchasing the said policy, the details of term and conditions given to the complainant. The submitted claim was considered and found not according to the same, hence was legally repudiated.
{{/usCountry}}Upon the notice, representatives of the company said that at the time of purchasing the said policy, the details of term and conditions given to the complainant. The submitted claim was considered and found not according to the same, hence was legally repudiated.
{{/usCountry}}Considering both sides, forum accepted the claims of the complainant and directed the insurance company to pay the claim amount under the policy while also directed to pay compensation to the complainant.