Reliance General Insurance Co Ltd has been ordered by a consumer forum here to pay over Rs 4.11 lakh to a policy holder for first denying him the cashless hospitalisation facility and then avoiding to reimburse his expenses on treatment.
The New Delhi District Consumer Disputes Redressal Forum asked Reliance General Insurance to pay the compensation, rejecting its contention that the medical history of the patient/policy holder had been manipulated by the hospital.
“We have gone through opposite party’s (Reliance General Insurance) written statement, in which it has taken a plea that Escorts Hospital manipulated the history, which clearly indicates the malafide intention and harassing attitude of the opposite party to torture consumers arbitrarily.
“It has also been noticed that the insurance company has deliberately avoided making the payment to complainant (Anil Kumar Gupta) from day one when he had contacted its agent for cashless facility which is totally unlawful. Opposite party is directed to make the payment of Rs 3,61,945 as per bills. We also award Rs 50,000 to the complainant as harassment and litigation cost,” the bench presided by C K Chaturvedi said.
In his complaint, Delhi resident Anil Kumar Gupta had said he had bought a cashless mediclaim policy for June 16, 2009 to June 15, 2010 from the firm through its agent.
He was admitted to Escorts Heart Institute on October 10, 2009 for chest pains, said Gupta adding that as he had the cashless mediclaim policy, he also contacted the insurance company’s agent for approval of the cashless facility.
He added that despite providing all necessary documents, the insurance company denied the cashless facility and later when he filed a claim for reimbursement of his treatment expenses, it too was rejected on the ground of pre-existing disease without any evidence, Gupta had said.
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