The Namakkal District Consumer Disputes Redressal Commission (DCDRC) ordered a private insurance company to pay a compensation of ₹2.5 lakh to a customer on Tuesday.
S. Venu Aravind (33), a resident of Velur Road near Tiruchengode in Namakkal district, sustained injuries on his right shoulder while swimming in a farm well in April 2018. For this, he underwent a surgery at a private hospital in Coimbatore. As he had medical insurance, he approached the insurance company. As the company refused his claims, he filed a case in the Namakkal DCDRC in 2019.
Inquiring into the case, the DCDRC stated on Tuesday that medical insurance companies should not refuse to provide medical expense amount according to law. Commission president V. Ramaraj said that in the policy provided by the insurance company, it said it would cover the expense of the surgery for torn muscle. But while the customer approached the company, it denied paying the expenses. “The policyholder pays for the policy in the hope that the insurance company will cover the medical expenses during a medical emergency. So the insurance company should pay ₹1.50 lakh as medical expenses, which should be paid with 9% interest calculated from March 2019, and ₹1 lakh for defects in service.
