Insurer to pay businessman mediclaim for treatment in blacklisted hospital

SURAT: The Surat district consumer dispute redressal forum has ordered a private insurance company to pay a businessman Rs 2.65 lakh mediclaim which it had rejected on the grounds that the hospital in which he took treatment was ‘black listed.’
Businessman Ankur Narang, a resident of City Light, had moved the consumer court in 2017 after his medical claim was rejected by IFFCO-TOKIO General Insurance from whom he had purchased a policy of Rs five lakh for one year beginning September 2015.
Narang had suffered injuries after a blast in his factory godown after fire. He was rushed to ‘Metas of Seventh Day Adventist Hospital’ on July 26, 2016 and got discharged on July 29.
He was operated for for fracture on his right hand and a plate was inserted. However, the plate got cracked later and he was again operated in November 2016 when he incurred Rs 2.65 lakh as treatment cost.
Narang’s claim was rejected by the company saying that the hospital was in its ‘excluded list.’
“We were neither informed by the company about the blacklisted hospitals nor informed that the claim will be not passed if we taken treatment there. We were not given any list of blacklisted hospitals at the time of insurance purchase,” Narang stated in his complaint.
Later, a compromise was reached between Narang and the company which agreed to pay him the actual medical expense. The court upheld the compromise.