HDFC Life Ins asked to pay Rs 55K to customer for not reimbursing claim

Hyderabad: The Hyderabad consumer dispute forum, on 1 July, directed the HDFC Life Insurance Private Limited and Paramount Health Services and Insurance TPA Private Limited to pay Rs. 55,000 to a customer for causing him mental agony and inconvenience.

The complainant, Mohammad Akram Ather Qureshi, a resident of Falaknuma, underwent a medical surgery in July 2018. His medical bill was around Rs. 1,27,636. He had applied for reimbursement from his health insurance provider but they did not reimburse his money.

“I applied for the claim in August 2018 after I was discharged from the hospital and submitted all necessary documents. HDFC Life Insurance Private Limited and TPA Private Limited, however, failed to consider my claim. So, I approached the consumer forum for redressal,” Mr. Qureshi said.

HDFC Life Insurance blamed Paramount Health Services and Insurance TPA Private Limited. “The claims documents were forwarded to Paramount Health Service and they are the only one authorized to settle the claim,” it said.

After examining the details, the forum said the HDFC Life insurance Limited and Paramount Health Services avoided sanctioning the claim claiming non-submission of documents even though it had received the necessary forms and bills.

“The non-settlement of the claim by the HDFC Life insurance Limited and Paramount Health Services amounts to deficiency in rendering services towards the complainant apart from adoption of unfair trade practice. As such, the point is answered accordingly in favor of the complainant, by holding that the HDFC Life Insurance Limited and Paramount Health Services jointly and severally liable,” the forum said.

The forum also asked the health insurance provider to pay the bill amount and interest of nine percent from the date of complaint. It directed both the health insurance providers to pay Rs. 55,000 to the complainant for causing him mental agony.