Surat / Vadodara: The health insurance company stands reject medical claims about reckless land once again rejected by the Consumer Court while making decisions in the case of a human being treated by covid.
The man who lives in the Karachiya Vadodara region receives RS 91,052 less United India’s insurance company managed state Ltd.
rejects the amount quoted by notifications issued by Vadodara Municipal Corporation (VMC).
The court refused to accept the arguments installed by the insurance company and third party administrators of Indian Genesis Insurance (TPA) Pvt Ltd.
The court in its order states that the VMC notification does not mention any package, but only mentions a list.
hospital.
“The complainants have taken rival company policies so that they are in accordance with the policy clause, it must approve the claims of complainants and do not quote any VMC notifications to reduce money,” The court stated that this case, the man had bought the RS 5 Lakh policy cover.
He spent Rs 1.9 lakh at Covid’s treatment at a private hospital in Karelibaug where he was accepted in September.
The insurance company only paid for Rs 1 lakh and the remaining amount deducted quoted the notification issued by VMC.
The court asked the insurance company to restore the remaining amounts along with the interest of 7% and also pay Rs 3,000 as compensation to the man.
The Civic’s body in the past has issued a notification of covid-appointed hospital categorization based on the facilities they have.
Categorization has limited the price that hospitals can charge fees for treating covid-infected patients.
During the second wave, VMC has even published aid numbers for their patients and relatives to reach if they find that the bill increases.
In April, TOI has highlighted the opinion of the legal brotherhood that VMC notices do not bind legally and cannot be used by insurance companies and TPAs to reject the number of claims.
Lawyers and experts say that VMC notification is not a law and therefore cannot be used by insurance companies.
‘VMC notification cannot be used to refuse claims’
