Ahmedabad Ombudsman Centre
Case No. 11-004-0358
Mr. P D Shah vs United India Insurance Company Ltd.
Award Dated: 30.11.2007
Partial settlement of Mediclaim: Claim for hospitalisation was settled after 16 months
by deducting an amount of Rs. 170675/- detailed under
1. Rs .63000/- towards physician, surgeon and anaesthesia charges : Later admitted
by the Respondent to be payable.
2. Rs. 85782/- towards Chemotherapy 6 cycles-Medicine Bills as per prescription of
the treating Oncologist from Hinduja Hospital, Mumbai. The Forum found the amount
admissible in totality.
3. Rs. 19008/- towards discount. The Respondent could not justify the deduction in the
Self Contained Note and in Hearing. So found admissible.
4. Rs. 1000/- pre-hospitalisation expenses paid to Doctor/Hospital.
In course of Hearing, the Respondent could not put forward any argument worth
recording and accepted the factual situation. As per analysis of the whole complaint it
was observed that an amount of Rs. 1885/- towards cost of registration, administration
charges and charges for linen, blanket etc. were not admissible. Due to the extreme
delay in settlement of claim, the balance amount was awarded with an interest at 6%.
