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Moneylife » Personal Finance » Consumer Interest » 'Penalise insurance companies for harassing customers'

'Penalise insurance companies for harassing customers'

MDT/PTI | 15/11/2012 03:26 PM | 

While ordering Apollo Munich Health Insurance to pay over Rs1.8 lakh to a policy holder for not reimbursing his treatment expenses, a Consumer Forum has asked the Finance Ministry to deal strictly with insurance companies that harass customers 

 
New Delhi: The Union finance ministry has been asked by a Delhi consumer forum to deal strictly with the private insurance firms and consider cancelling their licences for harassing customers and illegally rejecting their claims, reports PTI.
 
The East District Consumer Disputes Redressal Forum made this recommendation while ordering Apollo Munich Health Insurance Co Ltd to pay over Rs1.8 lakh to a policy holder for not reimbursing his treatment expenses and illegally cancelling his insurance cover after he submitted his claim.
 
"Private insurance firms are resorting to such acts just to save the amount which they are legally bound to reimburse to policy holders. This needs to be dealt with by appropriate authorities and license of such companies may be considered to be cancelled," said the forum's bench presided by NA Zaidi.
 
"Let copy of this order be forwarded to Secretary (Finance), Ministry of Finance, Govt. of India for perusal and strict action," it added.
 
The forum gave this order holding that the insurance firm "harassed and traumatised" the insured by their "unlawful action" and "illegal methods" to deny his rightful claim under the policy.
 
"Complainant (policy holder) of this case has been harassed, traumatised by the opposite party (Apollo Munich) by their unlawful action and illegal methods to deny rightful claim under the policy," the bench said, directing the insurance firm to reimburse the medical expenses of over Rs1.4 lakh incurred by policy holder. It also asked to pay him Rs40,000 as compensation.
 
The forum also comprising member T Vijayan observed that the policy holder had already been admitted for treatment prior to cancellation of his policy and refund of the premium and as he had already submitted his claim such termination "shall be deemed to be a device to deny his rightful claim." 
 
The order of the forum came on the plea of Delhi resident Ashok Kumar, who had bought a Health Shield insurance policy from Apollo Munich valid from 25 November 2010 to 24 November 2011 for Rs2 lakh.
 
Kumar had alleged that Apollo Munich had rejected his claim for medical expenses and cancelled his insurance policy after he submitted his claim for reimbursement.
 
The insurance firm in its defence had contended that Kumar's policy was terminated and his premium refunded as he had concealed that he was a diabetes patient.
 
The forum, however, rejected the contention saying the insurance firm renewed Kumar's policy not once but twice and "it was their duty to have him medically examined before renewal of the policy".
 

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4 Comments
Vaibhav Dhoka

Vaibhav Dhoka 2 years ago

As most of the sectors such as Mutual fund,Insurance ,banking etc have been opened for invetment for private playes such incidences have increased many folds.Therefore all should think twice before opening other sectors in FDI.They ARE and WILL be only here for GAIN and no other intention by HOOK or CROOK method.As seen from above order.

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Vaibhav Dhoka

Vaibhav Dhoka 2 years ago

As most of the sectors such as Mutual fund,Insurance ,banking etc have been opened for invetment for private playes such incidences have increased many folds.Therefore all should think twice before opening other sectors in FDI.They ARE and WILL be only here for GAIN and no other intention by HOOK or CROOK method.As seen from above order.

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nagesh kini

nagesh kini 2 years ago

The Forum's direction to the Ministry needs to be followed up vigorously.
In Medi-claim issues all the insurers are laws unto themselves and take undue pleasure in delaying and rejecting valid claims, including incentivizing their hand-maidens the TPA (who anyway ought to be done away with forthwith) to dodge claims.
I once represented at Insurance Ombudsman a very senior citizen whose claim for a trifling Rs.70,000 on the account of his dead spouse was rejected on very frivilous grounds. The insurance co and the TPA didn't put in appearance at the final hearing resulting in ex-parte ordering full claim.
Many prefer not to pursue injustice simply because the insurers only harass further - hike premium and/or delist the ailment on renewal or simply refuse to renew.
The TPA system to say the least is obnoxious and over time has proved to be a tool for harassment of hapless insureds.
It is time the IRDA implements the list of very valid suggestions submitted to its Chairman by MoneyLife. The Ministry of Finance need to ensure this.

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ROY SYDNEY

ROY SYDNEY 2 years ago

I have also approached Pune additional consumer forum against Cholamandalam Ins co who have rejected claim saying that pre existing condition.Unfair trade practice and deficiency in service are my complaints.

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