This story is from September 21, 2016

Consumer forum sets aside 24-hour mediclaim notice rule

The Thane district consumer redressal forum has directed an insurance company to honour a claim that it had denied on the grounds that the policy holder had failed to report his hospitalization within the mandated 24 hours.
Consumer forum sets aside 24-hour mediclaim notice rule
Thane: The Thane district consumer redressal forum has directed an insurance company to honour a claim that it had denied on the grounds that the policy holder had failed to report his hospitalization within the mandated 24 hours. The stipulation is a common clause in most medical insurance policies.
Calling the condition harsh, the forum ordered United India Insurance and Medsave Healthcare, a third party administrator (TPA), to release Rs 1.54 lakh to Bhiwandi resident Hafij-ur-Rehman Ansari (50), who incurred the expense during his hospital stay in 2010 for diabetes and hypertension.

The forum’s president, Sneha Mhatre, and member, N D Kadam, rapped the insurance firm and the TPA for their insensitive rule-book approach, given that medical treatment is a question of life and death for any insured person.
Ansari, who owns a powerloom, was admitted to Waris Nursing Home, Bhiwandi, during July 23-28, 2010, after he got acute fever, headache and neck pain. Following his diagnosis, which revealed that he suffered from haemorrhage with ventricular extension, he was treated in Jupiter Hospital.
On July 25, Ansari’s friend intimated the insurance firm about the hospitalization. Later, Ansari, insured at the time for Rs 1.72 lakh, lodged his claim, which the firm denied. This made Ansari approach the forum.
In its ruling, the forum said it was harsh of the firm to expect that the relatives and friends of a patient, who are focused on the person’s well-being and safety, should intimate the insurer of hospitalisation within 24 hours. The forum ordered United India Insurance to pay the claimed amount with 6% interest and additional compensation.
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