The Thane District Consumer Disputes Redressal Commission has held an insurance company, a hospital and a third party administrator (TPA) guilty of deficiency in services and asked them to pay nearly Rs 35,000 to a man over his insurance claim against his son’s medical treatment. The commission passed the order recently.
It asked them to pay Rs 19,964 with nine per cent interest from the date of submission of the claim, Rs 10,000 towards compensation and Rs 5,000 towards the cost of the claim. The complainant, Dilip Aswani, a resident of Kopri in Thane city told the commission that he had taken a medical insurance cover for his family members from the National Insurance Company Ltd.
In his submission, he said that in October 2015, his son was admitted to local Vedant Multispeciality Hospital in a critical condition for surgery of thrombosed hemorrhoid, but was discharged after some time due to denial of cashless facility and improper diagnosis, among other things.
Due to this, he had to be admitted to another hospital, where he was operated upon. The total medical treatment cost them Rs 98,990. He sought a claim for the entire amount. Accordingly, the claim was processed and sanctioned after Rs 19,664 deduction, he said.
The complainant in his submission said that he was entitled to get entire reimbursement without any deduction. He then approached the commission against Vedant Multispeciality Hospital, National Insurance Company Ltd and M D India Healthcare Services Pvt Ltd.
The commission ruled in his favour and held the insurer, the hospital and the TPA guilty of deficiency in services and unfair trade practice and asked them to pay compensation to him.