Court orders United Insurance to pay Rs 13,525 for denying medical claim due to short hospitalisation

A Delhi consumer court has ordered United India Insurance Company Limited to pay Rs 13,525 plus 6 per cent annual interest after the company denied a medical claim for a short hospitalisation. The court found that the company failed to provide adequate service, causing inconvenience and distress to the complainant, Raja Harpal Singh.

Background of the Case

The complaint, filed on November 6, 2023, by Singh, stemmed from the insurer's refusal to settle a claim related to the hospitalization and treatment of his wife. The insurance company rejected the claim, citing that the hospitalization lasted less than 24 hours. Singh argued that this was an unjust rejection.

Court's Ruling

The bench of President Inder Jeet Singh and Member Rashmi Bansal emphasized that the requirement of a minimum 24-hour hospitalization must be assessed in light of the specific circumstances of each case, particularly in emergencies. The court ruled against United India Insurance Company, imposing a fine of Rs 5,000 and litigation costs of Rs 3,000.

Details of the Hospitalization

Singh's wife was admitted to the emergency ward on March 31, 2023, at 4:09 AM and was discharged the same day at 6:06 PM. The court noted that her hospitalization was necessary, and the duration of her treatment was uncertain at the time of admission.

The court criticized the insurer for dismissing the claim without considering essential factors and failing to evaluate the patient's actual needs. While the insurance policy's clause stated a minimum of 24 hours of hospitalization for claims, the court noted that this guideline must be interpreted flexibly, considering the nature of emergency medical situations.

This ruling highlights the consumer rights upheld by the court and serves as a reminder for insurance companies to evaluate claims more comprehensively.