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Insurance firm pulled up by consumer forum for arbitrary decision

The South Mumbai district consumer dispute redressal forum on Monday pulled up the New India Assurance company guilty of arbitrarily deducting a claim made by one of its Versova-based consumers who had undergone a cataract operation in October 2009.

What did the fine amount to?
The forum directed the firm to pay back the total expense occurred to the consumer, which is Rs72,606, along with 6% interest on the amount from November 2009 onwards. The forum also directed the firm to pay an additional Rs15,000 and Rs5000 towards the complainant's mental agony and litigation cost, respectively.

What had happened to the consumer?
As per the forum's order copy, Prem Padma had, in 1991, purchased a mediclaim policy which had a claim cover of Rs3 lakh, and which was active till the year 2010.
In 2009, Padma started realizing a problem in her left eye, and thus sought medical opinion from an ophthalmologist, who asked her to undergo a cataract operation, which was done in October 2009.

What was the discrepancy?
After getting operated, Padma immediately sought for her medical claim of Rs72,606 from the firm on an immediate basis. However, in December 2009, the firm issued her a cheque of Rs46,106 and refused to issue the remaining amount of Rs26,500.
Despite Padma asking for the remaining amount to be cleared, it was not done. Thus, she refused to accept the previously disbursed amount and returned the cheque to the firm. Aggrieved by the firm's attitude, Padma filed a complaint at the firm in December 2012.

What was the firm's defense?
After going through the complaint, the forum asked the firm to file a reply. The firm then claimed that as per their rule book, the maximum amount which one needs for cataract surgery is Rs 40,000. However, in Padma's case, they had issued an amount of Rs 46,106. Thus claiming that they did not fail in providing service to their consumer.

Arbitrary attitude
The forum went through the arguments made by the complainant and the firm, and held that the rule upon which the firm had relied to deduct the amount, was not produced before the forum. "This clearly shows that the firm has acted arbitrarily while deducting the claim lodged by the complainant," the forum's order copy read.

 Article referred: http://www.dnaindia.com/mumbai/report-government-insurance-firm-pulled-up-by-consumer-forum-2034012

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