A district consumer commission in an order has directed The Oriental Insurance Company Ltd. to pay insurance claim of Rs 74,351 to legal heirs of a deceased with interest. The insurance firm had failed to respond to the claim of the Peddar Road resident who is now deceased either by passing or repudiating it. The commission held no response from the insurance firm and no follow up by the third party administrator (TPA) was deficiency in service. It directed that the claim amount be given with 10 % interest per annum from November 2014 by the insurance firm and that the legal heirs be given Rs 10,000 each by insurance firm and TPA towards mental agony. Insurance firm was directed to give additional Rs 10,000 towards litigation costs.
The order dated October 3 was passed by Ravindra P. Nagre, president (incharge) and Shraddha Jalnapurkar, member of District Consumer Disputes Redressal Commission, Suburban. It was passed on a complaint by Peddar Road resident Manjulaben Parekh (deceased) and represented by her two legal heirs against The Oriental Insurance Company Ltd. and Alankit Healthcare TPA Ltd.
Parekh had taken an insurance policy with a sum assured of Rs 4 lakh from Oriental. The policy period was from December 24, 2011 to December 23, 20122 for which she paid Rs 40,193 as premium amount. Between October 9, 2012 and October 14, 2012 she was admitted to Jaslok Hospital for treatment. The treatment cost her Rs 74,351. When she was discharged, she raised the claim on October 31, 2012. However, till June 2013 when the insurance firm did not respond, she sent legal notice. When there was no response to that too, she filed a consumer complaint, which was decided ex-parte as both sides did not appear.
The commission observed that documents proved that the complainant was treated at Jaslok Hospital and paid bills post which the claim was raised in reasonable time. It said that as per IRDA rules, the insurance firm should have taken a decision in a time bound manner which it did not and that was deficiency in service. It added that it was also the duty of the TPA to submit the claim form of the complainant to the insurance firm and take follow-up on whether it is settled or not and communicate the same to the complainant. By not doing the same, TPA had failed in its duty and so directed to give compensation towards mental agony.
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