• Health insurance reimbursement

Greetings! I had cashless health insuarance cover. But at the time of hospitalisation for my double valve replacement surgery I was denied cashless facility by TPA Park mediclaim. Instead I was asked to apply for reimbursement of the costs incurred post discharge. Which I did. But it took them Park mediclaim 8 months to settle my claim in full. O after many reminders and phone calls. Since my surgery was urgent in nature I was forced to borrow money from open market in hope that same will be reimbursed by company soon. Now I request your goodself if I am can take legal recourse to demand interest and compensation for humiliation I had to go while pacifying my lenders. Hope to hear from you soon.
Asked 1 year ago in Civil Law from Srinagar, Jammu and Kashmir
1) you can issue legal notice to park medi claim  for deficiency in service   and seek compensation for interest paid by you and for mental torture undergone by you 

2)you can seek compensation for delay in settling your claim . 

3) in your complaint you must mention that you borrowed money from market and paid interest for your surgery and hospitalisation expenses 

4) enclose evidence of loan taken and interest paid . 

5) also seek payment of costs for filing complaint before consumer forum 

5) contact a local lawyer .
Ajay Sethi
Advocate, Mumbai
23103 Answers
1212 Consultations
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Hi, you have to issue legal notice for deficiency of service and thereafter file a complaint before the consumer court for delay in payment and interest.
Pradeep Bharathipura
Advocate, Bangalore
4104 Answers
133 Consultations
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Hello,
1) You can certainly claim compensation and interest for the loss you incurred as you had to borrow from the market.

2) Hire a lawyer locally and issue a legal notice to the medical insurance company demanding the payment of interest and losses you incurred and compensate you for the humiliation you had to undergo.

3) In case they refuse to comply with the demand notice, file a case before the consumer forum for the same reliefs. As cashless cover was service offered you have a clear case against the insurance company.
S J Mathew
Advocate, Mumbai
1949 Answers
65 Consultations
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1. Yes, it is a good case to file before the Consumer Forum,

2. Collect evidence from the hospital about the refusal to pay by the TPA,

3. You already have the evidence that they have finally paid the same bill,

4. File a complaint case before the local District Consumer Dispute Redressal Forum alleging deficiency in service and unfair business practice claiming damage and cost,

5. Make sure to add the local office of the TPA to ensure that that your local Forum gets the jurisdiction to try your complaint case.
Krishna Kishore Ganguly
Advocate, Kolkata
12042 Answers
227 Consultations
5.0 on 5.0
It is advisable that a legal notice be issued to the mediclaim sseekingto reimburse the interest paid by u and the compensation for suffering humiliation.  Kindly read the terms and conditions of the insurance policy carefully before getting your legal notice drafted.

If no money is reimbursed then file a case of deficiency in service against them in the concerned consumer forum. Kindly do this at the earliest to remain within the time limit to file case before consumer forum
Shaveta Chaudhary (Sanghi)
Advocate, Chandigarh
821 Answers
60 Consultations
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Your is a case of deficiency of service and you can file case against the Insurance company in a Consumer Cour of Law.

In your complaints disclose all sequence of facts that happened right from the time you got admitted. 

Also attest as much documents and phone call list if you can.  

You may ask compensation of around Rs.25000/- for all inconvenience and mental torture that you underwent.

To start with send a legal notice to them covering all facts through a carefully drafted notice, you should claim the same Rs.25,000/- plus legal notice charges as compensation in your legal notice.   

Mostly the judges will favour awarding compensation though it may be less then what you ask for.
Bhaskaran
Advocate, Bangalore
21 Answers
0 Consultations
Not rated
1. The delay of 8 months in settling your claim is an act of deficiency in service, which entitles you to seek redressal from the court in the form of compensation. So move consumer forum to seek compensation. 

2. You will require documentary proof in the form of hospital bills and also of the money you borrowed from the open market for your treatment. 

3. You can also seek the cost of legal remedy i.e the fees of your lawyer. 

4. The fact that your claim was finally settled after 8 months shows that your claim was sustainable, in view thereof the insurance company will face the heat in the court.
Ashish Davessar
Advocate, Jaipur
18057 Answers
445 Consultations
5.0 on 5.0

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