Life Insurance

CHANDIGARH:Hopeful of getting justice, Panchkula resident VK Gupta approached consumerforum against insurance company and a private company to seek claim. WhenGupta's compliant was dismissed by the consumer forum he approached StateConsumer Commission against the order of the consumer forum.

The state consumer commissionwhile accepting his compliant with Rs 10,000 as costs, directed the respondents,director, Raksha TPA Private Limited, New Delhi and branch manager, The NewIndia Assurance Company Limited, Sector 17 to pay Rs 48,679 along with interestto Gupta.

The complainant,Gupta had alleged that he is a regular subscriber to medi-claim policy underhospitalisation and domiciliary hospitalisation policy since March 11, 2002. Hisfather was also a beneficiary under the medi-claim policy and was admitted in ahospital on February 19, 2004, where he remained before he died.

The appellant, Gupta allegedthat he had approached director, Raksha TPA Private Limited, New Delhi for freehospitalisation but the request was not entertained and ultimately Gupta paid Rs1,48,679 to hospital, even though his father was insured for Rs 2,50,000.

Gupta lodged claim with theopposite parties for refund of an amount of Rs 1,48,679. However, the oppositeparties on the plea repudiated his claim that the father of the appellant wassuffering from the same disease for which maximum amount payable was Rs onelakh, which has already been paid.

Alleging deficiency inservices, Gupta approached consumer forum, wherein director, Raksha TPA PrivateLimited, New Delhi was proceeded ex-parte by the consumer forum, as they did notappear despite service.

However, insurance companycontested in the consumer forum that during the course of treatment of Gupta'sfather, appellant alleged to have incurred Rs 1,48,679 for which the maximumslab was Rs 1 lakh. The insurance company added that this amount (one lakh) waspaid to Gupta in accordance with underwriting manual for standard medi-claiminsurance.

Though districtconsumer forum dismissed Gupta's compliant yet the state consumer commissionobserved that insurance policy is a contract between the insurance company andthe insured, VK Gupta, the complainant.

This is cache, read story here