Insurance firm directed to settle claims of patient
Commission directed the SBI to pay Rs 1,47,343 along with an interest at 9% for failing to settle the claims
Hyderabad: The District Consumer Disputes Redressal Commission-I directed the State Bank of India General Insurance to pay Rs 1,47,343 along with an interest at nine per cent for failing to settle the claims of a person who was insured with them and had undergone treatment.
As the two-year-old Mokshi Naga Venkata Sai was a minor, he was represented by his natural guardian and mother G. Durga Rani, a resident of Miyapur. They filed a petition before the commission against Paramount Health Services and Insurance TPA services, State Bank of India and State Bank of India General Insurance seeking compensation after the insurance company failed to pay their hospital and treatment bills.
The complainant stated that they had taken a family health insurance policy in 2015 from State Bank of India General Insurance through SBI.
Sai was born on April 18, 2016 and as per the terms and conditions, he was included in the policy and was thus fully covered for 90 days. He developed abrasions on the neck and was taken to Krishna Children’s Hospital on August 22, 2017.
On medical examination, he was diagnosed with TB and underwent surgery. An amount of Rs 49,683 was paid towards medical expenses. Post-surgery, the boy was kept under observation for convalescence before he was discharged. Later, Naga Sai was taken to the hospital for a regular check-up. Based on the report, he was asked to be admitted to Krishna Children’s hospital for 10 days in October. The family incurred an expenditure of Rs 97,660. The complainant sent the medical reports and bills to the respondents to settle the claims.
However, the insurance company sent a letter seeking to know how he had developed bronchitis. The complainant submitted that this conduct was nothing but grave deficiency of service. This has caused financial loss, mental agony and harassment.
The commission directed SBI General Insurance to pay the claim amounts of Rs 49,683 and Rs 97,660 for an overall Rs 1,47,343 along with an interest of nine per cent from the date of payment till the date of realisation. It also directed an additional payment of Rs 20,000 for causing mental agony and another Rs 10,000 as costs.