DEAR VIEWERS,
Worli-resident, Ria Alamchandani had taken a health insurance policy from New India Assurance Company. According to standard procedures, the customer submitted her photograph along with the policy form, listing her sex as female. The medical insurance policy was issued for Rs 2 lakhs.
In May, 2009, Ria was admitted to a hospital in Marine Lines and with Acute Appendicitis and had to undergo an emergency appendix operation. The hospital authorities sent a request to the third party administrator (TPA) with the estimated cost of the operation and hospitalisation, requesting authorization for about Rs 65,000.
To the surprise of the policyholder and her family, the TPA reverted saying that the expenses could not be sanctioned as the policy listed the sex of the policyholder as male.
Ria’s father Rajan, contacted the insurance company who in turn told the TPA that it was an error and sent a fresh endorsement. Following this, the TPA contacted the hospital authorities to tell them that Rs 40,000 had been sanctioned.
The policyholder’s father moved the South Mumbai District Consumer Disputes Redressal Forum stating that the word Ms before name of the policyholder clearly suggests that she is a female. In addition to this Ria had also submitted her photograph along with the policy form.
Ria will be paid compensation of Rs 10,000 plus litigation costs of Rs 5,000. The Forum has directed the insurer New India Assurance to conduct an inquiry to find the employee whose error caused the policyholder mental agony.
In May, 2009, Ria was admitted to a hospital in Marine Lines and with Acute Appendicitis and had to undergo an emergency appendix operation. The hospital authorities sent a request to the third party administrator (TPA) with the estimated cost of the operation and hospitalisation, requesting authorization for about Rs 65,000.
To the surprise of the policyholder and her family, the TPA reverted saying that the expenses could not be sanctioned as the policy listed the sex of the policyholder as male.
Ria’s father Rajan, contacted the insurance company who in turn told the TPA that it was an error and sent a fresh endorsement. Following this, the TPA contacted the hospital authorities to tell them that Rs 40,000 had been sanctioned.
The policyholder’s father moved the South Mumbai District Consumer Disputes Redressal Forum stating that the word Ms before name of the policyholder clearly suggests that she is a female. In addition to this Ria had also submitted her photograph along with the policy form.
Ria will be paid compensation of Rs 10,000 plus litigation costs of Rs 5,000. The Forum has directed the insurer New India Assurance to conduct an inquiry to find the employee whose error caused the policyholder mental agony.
.....EDITOR
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