Insurer instructed to refund invoice from blacklisted hospital, Well being Information, ET HealthWorld

Ahmedabad: Insurer told to refund bill from blacklisted hospitalAhmedabad: The Gujarat State Shopper Dispute Redressal Fee has ordered an insurance coverage firm to pay mediclaim to a affected person for remedy obtained in a hospital that was blacklisted by the insurer.

The case entails Jagdishbhai Tandel from Navsari.

In July 2015, he suffered ache in his proper hand and neck, and was admitted to an orthopaedic hospital run by Dr Rajesh Kumar. He was discharged in 10 days after remedy. Tandel, who had medical insurance cowl from New India Assurance Co Ltd by way of Well being India TPA Companies Pvt Ltd, sought reimbursement of Rs 33,925 — the medical expenditure incurred throughout hospitalisation.

The insurance coverage firm repudiated his declare, saying the hospital had been black-listed by the corporate in July 2010.

Tandel unsuccessfully approached the patron district discussion board in Navsari. He filed an attraction within the state fee, the place his advocate M Okay Dudhiya contended that Tandel had obtained the well being cowl in 2009 and there was no record of blacklisted hospitals then.

The blacklisting of hospitals befell in 2010 and the patron was not offered an inventory of those hospitals though the coverage was usually renewed yearly.

The fee accepted the argument that the blacklisted hospital was not throughout the information of the insured individual and subsequently the bar imposed by the insurance coverage firm is non-binding to the insured individual.

The fee quashed the Navsari district discussion board’s resolution and ordered the insurance coverage firm to reimburse the quantity with 7% curiosity since December 2015.

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