The district consumer disputes redressal commission has penalized United India Insurance Company for unjustly denying the medical claim of Kulwinder Singh, a resident of Goslan village, Samrala. The commission ordered the insurance company to pay Rs.79,606, covering hospital bills, with an 8% annual interest rate and an additional composite fee of ₹20,000 to Singh.
Kulwinder Singh approached the commission on June 28, 2021, regarding a cashless treatment insurance policy purchased through PolicyBazar. The policy, valid from June 27, 2018, to June 26, 2019, insured him for Rs.1 lakh at a premium of Rs.2,006.
On May 31, 2019, Singh experienced severe stomach pain and consulted a local physician, who prescribed medication. As his condition worsened, he was admitted to Dayanand Medical College and Hospital (DMCH), where he was treated for acute pancreatic disease, loose motion, and fever. Singh applied for cashless treatment on June 1, 2019, but the insurance company rejected his claim. He reapplied on June 2, 2019, including doctors’ opinions that hospital admission was necessary.
Despite two insurance company employees visiting the hospital and reviewing records, the company maintained that his treatment could be managed on an outpatient basis and denied cashless treatment. Singh was discharged on June 9, 2019, and due to financial constraints, borrowed money from siblings to cover the bills. He applied for reimbursement on June 22, 2019, submitted original bills on September 2, 2019, but his claim was again rejected in December without a specified reason.
The insurance company argued that hospitalisation was unnecessary and the claim was non-payable. However, the commission upheld the treating doctor’s opinion, emphasizing the urgency of Singh’s admission and the potential for severe health repercussions if untreated. The commission concluded that Singh’s condition warranted hospital care and criticized the company’s decision.
This ruling reinforces the importance of insurance companies honoring legitimate claims and provides a reminder of the consumer’s right to fair treatment.
