The Ahmedabad (rural) Consumer Disputes Redressal Forum has held the Oriental Insurance Company guilty of deficiency in service and ordered it to pay Rs 46,000 to one Sarojini Khemka.
The company has also been asked to pay nine per cent compound interest on the amount from the date of the complaint till the payment is made and additional amount of Rs 5,000 as compensation for mental agony,harassment and the cost of litigation. According to details of the case,Sarojinis husband,Ram Nandlal Khemka,had taken a healthcare policy from Oriental Insurance. During the term of the policy,he was admitted to Lifeline Nursing Home on June 17,2005,as he had been suffering from constant high fever. After three days in hospital,he developed an acute pain in the abdomen and a CT scan showed a mild intestinal obstruction. After medication,he was discharged on 30 June. But the insurance firms local agent,Paramount Health Services Ltd (PHSL),refused the cashless service on grounds that the abdominal pain was attributed to a 20-year-old intestinal disease for which the patient had undergone appendectomy.
On September 13 that year,Sarojini approached the Consumer Education and Research Society (CERS) and informed that her husband had expired a week ago. CERS issued legal notices to the parties concerned for insurance claim,but the parties repudiated the same,as a result of which CERS and Sarojini approached the consumer forum.
The forum observed that the opposite parties had not produced any documentary evidence to prove how the abdominal pain suffered by the deceased was related to a 20-year-old disease. The forum said that by denying the mediclaim to the complainant,the opposite parties had committed negligence and deficiency in their service.