Insurance firm fined for refusing claim

Kasaragod: The consumer dispute redressal commission, Kasaragod has ordered the Bajaj Allianz Insurance company to pay a compensation of Rs 25000 to a Kasaragod native for denying reimbursement of his son's hospital bill. The commission also instructed the insurance company to reimburse the bill with an 8 percent interest and Rs 5000 as cost of litigation, within 30 days.As per the complaint lodged by Joseph Daniel, his son was admitted at the Kasturba medical college hospital, Mangaluru on July 14, 2021 and discharged on July 16. He underwent treatment for bilateral ulnar entrapment neuropathy.
The family paid a bill of Rs 69403 for the treatment and Joseph had a family health cover of Rs 2 lakh with Bajaj Allianz. But, the insurer refused to reimburse the hospital bill, saying his son's admission to the hospital was for diagnosis and not for treatment.
While considering the case, the commission observed that the insurance company failed to produce evidence to prove that the admission was only for diagnosis. At the same time, the petitioner produced required documents including a certificate issued by the doctor, discharge summary, lab reports and bills before the commission. tnn