Times of India
12 November 2010
By Viju B
Mumbai, India

The South Mumbai District Consumer Disputes Redressal Forum (SMDCRF) has penalized a public sector insurance firm for delaying a health check–up claim as per policy norms.

Worli resident Rajan Alimchandani and his wife had taken a mediclaim policy from New India Assurance company. As per clause 10 of the policy, the company offered a free health check–up if no claims were made for four years.

"I had taken the insurance in 1996 for a sum of Rs 1 lakh and my wife was insured for Rs 20,000. After we underwent a medical check–up, we decided to avail of this reimbursement facility and submitted claims of Rs 2,200 and Rs 2,500 respectively. We had also accumulated many bonus points over the years and were eligible for this facility," Alimchandani said.

But the couple got no response from the company for months. Alimchandani said when he called up the company officials, they would only assure that they were following up the matter. "After three months, I received a part payment of Rs 2,200. But my wife’s claim remained unsettled. When we corresponded with the company, there was no response,"

Alimchandani said. To his shock, instead of getting the reimbursement charges, he got a renewal notice where their cumulative bonus, which had accumulated to around Rs 1 lakh, was shown as nil. "The officials claimed that there was no problem in their records as they were computerized It was only when I threatened to go to the higher–ups that this problem was rectified," he said. Finally, Alimchandani’s wife got the claim after eight months of delay and that, too, when he threatened to file a case in the consumer court.

Alimchandani filed a case with the consumer forum for deficiency of service last year. The insurance firm admitted that the bonus column was showing nil due to a clerical error. "We deny any deficiency in service. We assure the best service and are sorry forthe delay," the counsel for the company said. The forum passed an order that there has been a delay in reimbursing the claims and directed the firm to pay Rs 5,000 for deficiency in service. "I filed the case to make people aware that they should claim their insurance rights as conferred upon us by the Insurance Regulatory Development Authority , which specifies that all claims have to be settled in 15 days of receipt," Alimchandani said.