Insurance Ombudsman asks Insurer to pay for delay in claim settlement

Ahmedabad Ombudsman Centre

Case No. 11-004-0358 

Mr. P D Shah vs United India Insurance Company Ltd. 

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Award Dated: 30.11.2007

Partial settlement of Mediclaim: Claim for hospitalisation was settled after 16 months 

by deducting an amount of Rs. 170675/- detailed under 

1. Rs .63000/- towards physician, surgeon and anaesthesia charges : Later admitted 

by the Respondent to be payable. 

 

2. Rs. 85782/- towards Chemotherapy 6 cycles-Medicine Bills as per prescription of 

the treating Oncologist from Hinduja Hospital, Mumbai. The Forum found the amount 

admissible in totality. 

 

3. Rs. 19008/- towards discount. The Respondent could not justify the deduction in the 

Self Contained Note and in Hearing. So found admissible. 

 

4. Rs. 1000/- pre-hospitalisation expenses paid to Doctor/Hospital. 

In course of Hearing, the Respondent could not put forward any argument worth 

recording and accepted the factual situation. As per analysis of the whole complaint it 

was observed that an amount of Rs. 1885/- towards cost of registration, administration 

charges and charges for linen, blanket etc. were not admissible. Due to the extreme 

delay in settlement of claim, the balance amount was awarded with an interest at 6%.