Private health insurance company directed to reimburse customer Rs 1.69 lakh

COIMBATORE: The district consumer redressal commission has directed a private health insurance company to reimburse a customer a mediclaim amount of Rs 1.69 lakh and pay a compensation of Rs 10,000 for mental agony after his claim was denied without a valid reason.

Also, the commission comprising its president R Thangavel and member P Marimuthu directed the health insurance company to pay the customer Rs 5,000 towards the cost of proceedings.According to official sources, C Saravanakumar of Samalapuram in Tirupur district took a health insurance policy from a private insurance company, covering the period from Jan 27, 2022, to Jan 26, 2023, for a sum of Rs 3 lakh. As per the terms and conditions of the insurance, either Saravanakumar and his parents were entitled to undergo medical treatment in any hospital under the cashless facility or the pay-and-recover method.On Aug 18, 2022, Saravanakumar’s mother developed severe stomach pain and fever and was immediately admitted to a private hospital. She was diagnosed with multiple ventral hernias in both lateral aspects of the lower anterior abdomen. After treatment, Saravanakumar applied for a claim of Rs 1.69 lakh. However, the insurance company rejected the claim without any valid justification.Subsequently, Saravanakumar filed a petition with the Coimbatore district consumer disputes redressal commission.