Kasaragod: The Consumer Disputes Redressal Commission, Kasaragod, directed Bajaj Allianz General Insurance Company Limited to pay a compensation of Rs 25,000 to a client for refusing to reimburse his son's hospital bills. It also ordered the insurer to reimburse the bills with an 8% interest.
Bajaj Allianz refused to reimburse the bills of Rs 69,403 of Joseph Daniel, saying his son's admission to the hospital for three days was for diagnostic and evaluation purposes and not for treatment.
The redressal commission noted that Bajaj Allianz, represented by Adv Vinod Bhattathiripad, produced no evidence during the hearing to prove that the admission to the hospital was only for diagnosis.
In contrast, Joseph Daniel, a resident of Kanhirapoyil in Madikai grama panchayat, produced the certificate issued by the doctor, discharge summary, lab records and hospital bills before the commission.
His son, Sharon Joseph, was admitted to Mangaluru's Kasturba Medical College (KMC) on July 14, 2021, and discharged on July 16, 2021. He underwent treatment for bilateral ulnar entrapment neuropathy. In this condition, the ulnar nerve -- that runs from the neck, down the arm and to that hand -- is pinched or squeezed in the elbow or wrist, leading to symptoms such as numbness, tingling, or pain in the ring and little fingers.
Sharon ran up a bill of Rs 69,403 in the three days and his father paid the amount at the time of discharge.
Joseph Daniel expected the bills to be reimbursed as he had a family health cover of Rs 2 lakh with Bajaj Allianz since December 28, 2012, said Adv TC Narayanan, who represented him before the commission. Joseph Daniel used to renew the policy by paying a premium of Rs 10,795 every year.
When the insurer rejected his claim, Joseph Daniel approached the Consumer Disputes Redressal Commission under Section 35 of the Consumer Protection Act, 2019.
In their order, the commission's president Krishnan K and member Beena said that Bajaj Allianz's decision to reject the bills was bad in law, unjustifiable, and amounted to a deficiency in service by the insurer.
They directed Bajaj Allianz to reimburse the hospital bill of Rs 69,403 along with an 8% interest per annum from the date of filing the complaint till the payment, a compensation of Rs 25,000 and Rs 5,000 as cost of litigation within 30 days of the receipt of the order.