Insurer asked to reimburse 86-yr-old’s hosp bill, pay relief

CHENNAI: A consumer forum directed an insurance firm to reimburse the medical expenses to an elderly woman, who was denied reimbursement of the hospital bill despite being eligible for cashless insurance. The Chennai (South) District Consumer Disputes Redressal Forum also asked the United India Insurance Company Limited to pay compensation and cost to the 86-year-old woman who retired from government service.

As per the case, P Kamalammal had an accidental fall at her residence on December 5, 2018, and sustained injuries. She was unable to move her right upper hand. After examination, the doctors had advised her to undergo a surgery and internal fixation of proximal humerus, the upper part of the hand, on December 8, 2018.

Immediately after admitting her to the hospital, Kamalammal’s son met the representative of the insurance company available in the hospital to raise a claim for cashless treatment. She was eligible for the facility according to the health insurance policy. But the representative advised her son to pay the hospital expenses initially and claim reimbursement after getting discharged.

However, after she paid the hospital bill, the insurance company refused to reimburse the medical expenses despite repeated requests.

Alleging that the poor response from the insurance company caused mental agony and inconvenience to her, Kamalammal sought the consumer forum to direct the firm to reimburse the hospital expenses of Rs 2.4 lakh and also grant her a compensation of Rs 2.5 lakh.

As the insurance firm had failed to make an appearance, the forum president M Mony and member R Baskarkumaravel allowed the complaint in part and passed an ex parte order, directing the insurer to reimburse medical expenses incurred. The company was also asked to pay another Rs 30,000 towards compensation for mental agony and cost of Rs 10,000 to the complainant.