Man gets full medical insurance after 2 years

City-based consumer forum has awarded a man complete claim for his hospital bill for the hernia surgery that he underwent.

Pravinchandra Soni had underwent hernia surgery in 2009 and had paid a bill of Rs 24,010. The insurance company – Oriental Insurance Company Ltd- only partially settled the claim and limited the amount to Rs 9,300 only. The insurance company said that the insurance cover was given under the Universal Health plan in 2004 and it was converted into a mediclaim policy at a later stage. The new plan stated that treatment for hernia was excluded for a period of two years. As the operation was performed within the first year of the new plan, the company is not liable to pay the entire cost of the operation.

Consumer Education and Research Society moved Consumer Disputes Redressal Forum, Ahmedabad (City) on Soni’s behalf. The forum in a recent order has accepted a plea objecting to unfair trade practice adopted by Oriental Insurance. The forum headed by the President A K Aswani has directed the insurance company to pay Rs 24,776 (Rs.15000 – limit for hernia as per old insurance plan and Rs 9776 (extra amount charged for premium of 2 years) with 9% interest from October 7, 2009. The forum also awarded Rs 2,000 towards litigation cost and Rs 3,000 as a compensation for the agony faced by Soni.