Ahmedabad, Feb 23 (UNI) The Consumer Disputes Regressal Forum, Ahmedabad held the Royal Sundaram Alliance Insurance Company, Chennai guilty of deficiency in service and has directed the company to pay compensation to the complainant with interest.
The Forum, in a recent order, directed the company to pay complainant, Asha K Multani, Rs 80,468 with 6 per cent interest from February 19, 2004, until realisation and Rs 5,000 as compensation towards mental agony.
It also ordered the payment of Rs 5,000 each to Asha and Consumer Education and Research Society (CERS) towards the cost and execution of the orders within 30 days.
Asha was insured under a Royal Sundaram Health Shield policy through Citi Bank Good Health Policy system. On September 1, 2003, she was admitted to a hospital with stomach ache and underwent a surgery for the removal of gall bladder. After being discharged from the hospital, she submitted the hospital bill amounting to Rs 80,468 to Royal Sundaram for reimbursement.
However, the company repudiated her claim on the grounds of pre-existing disease and stated the gallstone would have been in existence at the time of taking the policy.
The company also denied continuation of the insurance policy.
Asha then approached CERS on July 2005. The CERS challenged the company and proved that Asha had the Mediclaim policy from November 30, 2000, with New India Assurance Company, which she later transferred to Royal Sundaram. Therefore, it was not a fresh policy but a mere continuation of the existing one.
Besides, the Forum also observed that the insurer had failed to prove the pre-existence of the disease.
UNI
The Forum, in a recent order, directed the company to pay complainant, Asha K Multani, Rs 80,468 with 6 per cent interest from February 19, 2004, until realisation and Rs 5,000 as compensation towards mental agony.
It also ordered the payment of Rs 5,000 each to Asha and Consumer Education and Research Society (CERS) towards the cost and execution of the orders within 30 days.
Asha was insured under a Royal Sundaram Health Shield policy through Citi Bank Good Health Policy system. On September 1, 2003, she was admitted to a hospital with stomach ache and underwent a surgery for the removal of gall bladder. After being discharged from the hospital, she submitted the hospital bill amounting to Rs 80,468 to Royal Sundaram for reimbursement.
However, the company repudiated her claim on the grounds of pre-existing disease and stated the gallstone would have been in existence at the time of taking the policy.
The company also denied continuation of the insurance policy.
Asha then approached CERS on July 2005. The CERS challenged the company and proved that Asha had the Mediclaim policy from November 30, 2000, with New India Assurance Company, which she later transferred to Royal Sundaram. Therefore, it was not a fresh policy but a mere continuation of the existing one.
Besides, the Forum also observed that the insurer had failed to prove the pre-existence of the disease.
UNI
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