Consumer commission directs Oriental Insurance to reimburse over Rs 1.88 lakh medical claim

It rejected the companys arguments that the complainant did not submit the requisite documents.

A district consumer commission here has directed an insurance company to reimburse a man's medical claim amount of more than Rs 1.88 lakh along with a compensation of Rs 7,500 for deficiency in services.

The direction of the District Consumer Disputes Redressal Commission (East Delhi) came on the man's complaint that the amount was not paid to him despite submitting a claim of Rs 1,88,729 along with requisite documents to Oriental Insurance Company Ltd in 2017.

The commission, comprising President S S Malhotra and Members Rashmi Bansal and Ravi Kumar, in a recent order noted that the complainant's wife was taking treatment at AIIMS and the raised claim was not disputed by the insurer. It rejected the company's arguments that the complainant did not submit the requisite documents. ''Fact otherwise is well proved that the complainant has filed all the necessary documents along with the complaint and exhibited all the documents. Therefore, it appears to the commission, that the contention that the complainant did not cooperate or did not furnish the document/details appears to be an afterthought,'' the commission said.

Stating that not reimbursing the claim amounted to deficiency in services, the commission directed Oriental Insurance to pay the amount with interest along with Rs 7,500 as compensation and Rs 5,000 as litigation costs.