Delhi Consumer Court Orders Insurance Company to Reimburse Policyholder for Rejected Medical Claim

A consumer court in New Delhi has ruled in favor of Raja Harpal Singh, directing United India Insurance Company Limited to reimburse him Rs 13,525 with an interest rate of 6% per annum from the date of complaint filing. The court found the insurance company guilty of a deficiency in service for denying Singh’s medical claim.

The bench, comprising President Inder Jeet Singh and member Rashmi Bansal, reviewed the complaint initially filed on November 6, 2023. Singh asserted that the company had unjustly refused his claim related to his wife’s hospitalisation and medical treatment.

The insurance company’s basis for rejecting the claim was that Singh’s wife’s hospital stay was less than the 24 hours stated in the policy terms. However, the court argued that the minimum 24-hour hospitalisation clause should be considered alongside the specific circumstances of each case, especially in emergency situations.

Singh’s wife was admitted to the emergency ward on March 31, 2023, at 4:09 am and released later that day at 6:06 pm. The court highlighted that at the time of hospitalisation, the treatment duration was uncertain, and the insurer should not disregard these crucial factors.

The court additionally imposed a fine of Rs 5,000 on the insurance company and ordered litigation costs of Rs 3,000. It emphasized the need to interpret policy clauses in a manner that considers both traditional practices and the individual’s emergency treatment needs.