National Insurance Company Held Liable For Deficiency In Service For Denying Full Policy Amount To Complainant.

Very recently the District Consumer District Redressal Commission Ernakulam held National Insurance Company Ltd liable for deficiency in service. The Complainant bought an Insurance Policy from National Insurance Company Ltd (Opposite Party) for the period 28.11.2021 to 27.11.2022. On 07.10.2022, the Complainant was admitted in Rajagiri Hospital, Aluva for knee replacement and was discharged on 12.10.2022. She incurred Rs.2,26,117 on the hospital treatment and claimed the amount from the Opposite Party. But according to the Complainant, she received only Rs.77063 despite the policy amount being Rs.280,000. The amount also included the cumulative bonus. Asserting the right to receive the remaining amount, the Complainant approached the Opposite Party and informed that the Opposite Party was liable to make the entire payment of the policy amount. The Opposite Party is purported to have not taken into account the grievance of the Complainant. Later on, the husband of the Complainant issued a Legal Notice to the Opposite Party, but without proper reasons assigned. Therefore, the Complainant approached the District Consumer Disputes Redressal Commission Ernakulam claiming the entire policy amount and compensation for having endured mental agony, suffering and other hardships due to the Opposite Party. On going through the documents such as policy card, discharge summary, legal notice and hospital bills which the Complainant furnished, the Commission noted that the Complainant had availed the policy from the Opposite Party to spend the amounts on the treatment and according to the documents, the policy amount was Rs.2,00,000. Additionally, according to the documents, a bonus of Rs.40,000 was also to be included in the total amount. The Commission ruled that according to the documents, the Complainant was actually to receive Rs.1,49,054. Also, the Complainant had been hospitalized for a duration within the policy period, the Commission noted. As the Opposite Party failed to appear, it proceeded against Ex-Parte. The Commission noted that the Opposite Party had rejected the Complainant's entire claim on inadequate grounds. Hence, considering that the Opposite Party failed to provide an adequate reason to reject the Complainants' claim, the Opposite Party was held lacking in service. Thus, the Opposite Party was ordered to pay the balance claim amount of Rs.1,49,054 along with Rs.5000 as compensation for service deficiency and Rs.5000 as litigation cost. Published by **Voxya** as an initiative to help consumers in resolving consumer complaints.