HYDERABAD: The A.P. State Consumer Disputes Redressal Commission has rejected the repudiation of a policy-holder’s claim by a health insurance company and ordered it to pay compensation.
The commission disposed of the appeal by Royal Sundaram Alliance Insurance Company Ltd. and upheld the order by the Krishna District Consumer Forum towards reimbursement of the medical expenses incurred by B. Ramanadham, a policy holder. Mr. Ramanadham, a resident of Vijayawada, had taken Health Shield Insurance Policy and Hospital Cash Insurance Policy from Royal Sundaram Alliance. Under these policies, he was entitled to full reimbursement of treatment expenses up to Rs.1 lakh apart from Rs.1,000 a day as inpatient treatment charges. Mr. Ramanadham visited the NRI General Hospital at Chinakakani in Guntur district in June 2007 with the complaint of a backache. He was admitted to inpatient ward of the hospital in August 2007 and discharged after 10 days.
Mr. Ramanadham filed a claim with the company for Rs. 10,525 towards daily treatment charges and Rs.14,725 for treatment expenses. The company agreed to pay only daily treatment charges and rejected the claim for treatment expenses saying that his backache was a pre-existing ailment. The policy holder challenged the company’s decision in the Krishna District Consumer Forum. The District Forum gave a ruling in favour of Mr. Ramanadham in April by considering backache as a natural ache and not pre-existing aliment. Royal Sundaram opposed the Forum’s ruling and appealed in the State Forum for its reversal. However, the State Forum upheld the directive of the lower forum on July 7. It ordered the company to pay Rs.10,525 and Rs.14,725 respectively for inpatient and treatment charges with 9 per cent annual interest and costs of Rs.1,000 to the policy-holder.