Holding that ICICI Lombard General Insurance was deficient in its services while dealing with a claim, the district consumer forum here has asked the company to pay a compensation of Rs 2.50 lakh to a policy holder.
In their recent ruling, Thane District Consumer Redressal Forum President Umesh Jhavalikar and Member N D Kadam also directed the private insurer to pay the medical claim amount of Rs 37,858 within 30 days from the date of order to the complainant, Hiralal Sobhraj Keswani.
As per guidelines of insurance watchdog IRDA, if a person files claim and submits relevant documents within the stipulated period, the insurer is bound to take a decision on it and communicate the same to him/her within a time-frame, the quasi-judicial body pointed out.
However, in this case the insurer has kept the claim pending for “unduly long period” without justified reason and hence it can be construed that the insurer was deficient in its services, the Forum observed.
Keswani, a resident of Ulhasnagar, had taken a medical insurance policy from ICICI Lombard which was valid till November 2008. On January 13, 2008 he had chest pain and underwent angiography at a well-known private hospital that cost him Rs 37,858.
He submitted his claim to ICICI Lombard for the amount with relevant documents on January 24, 2008. The company sought some more papers from the complainant which he provided from time to time. But despite repeated reminders, the firm didn’t respond to his query regarding the claim.
In January 2009, Keswani sent a legal notice to the company that again sought certain documents, which he had already submitted. According to the claimant, ICICI Lombard kept the claim pending for unjustified reasons.
On its part, the company argued that Keswani’s claim was not in order and hence it was rejected.
However, the Forum held the policy holder had provided all relevant papers and there was no reason for ICICI Lombard to keep the claim pending.
This amounted to deficiency in service, the Forum said and ordered the company to pay Rs 2.50 lakh to Keswani for causing mental suffering and towards legal expenses.