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The New India Assurance Company to compensate for wrongful rejection of claim

Consumer Education and Research Society ordered The New India Assurance Company to compensate Mr. Natvarbhai Patel for wrongful denial of claim. The forum, in addition

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Last Updated - May 16, 2023
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Consumer Education and Research Society ordered The New India Assurance Company to compensate Mr. Natvarbhai Patel for wrongful denial of claim. The forum, in addition to the claim amount along with 8% interest amount, asked The New India to pay Rs. 4,000 towards mental suffering caused and Rs. 3,000 towards court case charges.

The fact of the case is that, Mr. Natvarbhai Patel who had purchased health insurance policy from The New India Assurance Company Limited for his family members in the year 1999. In the year 2009 his son was hospitalized for the treatment of haemolytic anaemia and spherocytosis with splenomegaly and jaundice. He was also operated for laparoscopic splenectomy surgery and later discharged.

After his son’s discharge, he put forward his hospitalization claim to the company for Rs. 123,142. The Company rejected the claim on the ground that the disease is due to hereditary disorder.

Aggrieved by the wrongful rejection of claim, Mr. Patel approached the Consumer Education and Research Society and along with the fact of the case put forward the doctor’s certificate stating that the syndrome is not a hereditary external shortcoming.

After hearing both the parties, the forum arrived at a conclusion that the company’s denial of claim was not based on any merits and that Mr. Patel be adequately compensated as above for the mental harassment caused to him.

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