Bengaluru: A Bengalurean, whose claim for medical reimbursement of Rs 71,000 that was not processed by his health insurance firm, approached the city’s II additional district consumer disputes redressal commission, which recently ordered the latter to settle the claim. It also ordered a refund of the Rs 15,972 he had paid as premium for another plan that he was denied.
Umesh C, 36, of Kempegowda Layout, Laggere, off Peenya, purchased a family insurance policy from Redkenko Health Tech Pvt Ltd on a promise that the plan would cover 10 days of hospitalisation and 50% OPD. Yet, when he was hospitalised on April 16 and 17, 2024, his Rs 71,000 claim was flatly denied.
On the promise he would be provided with a “forever family plan” covering 100% of medicine and consultation costs and hospitalisation expenses up to Rs 20 lakh, Umesh also paid the insurance firm a premium of Rs 15,972. Due to health score issues, the renewal premium was rejected. The complainant sent an email and the company agreed to refund the premium.
However, neither the refund nor the Rs 71,000 claim materialised. Umesh escalated the issue to every authority possible: The National Consumer Forum, Insurance Regulatory and Development Authority, RBI ombudsman, and even JC Nagar police. He visited the company’s Bengaluru office, only to find it shuttered. He also sent a legal notice on June 10, 2024, to the firm’s headquarters in Mumbai and the regional office in Bengaluru. But there was little progress.
Firm a no-show
A frustrated Umesh filed a complaint on July 11, 2024 with the consumer forum, alleging deficiency in service. The insurance firm failed to appear before the commission even after receiving notice.
The commission, after reviewing all the documents and evidence (transaction details, hospital bills, plan benefits, etc), noted that despite receiving multiple notices, the insurance company never appeared before the commission to contest the allegations, indicating that Umesh’s claims remained unchallenged and were backed by strong documentary evidence.
The commission also said Redkenko collected premiums and falsely assured coverage, only to deny claims when the same was sought. The commission remarked Redkenko had been ‘misleading customers with false advertisements and unfulfilled commitments,’ making Umesh one of the many victims.
The commission ordered the insurance company to pay Rs 86,972 (Rs 71,000 + Rs 15,972) with 6% interest from the date of complaint till the realisation, and an additional Rs 10,000 for mental agony and legal costs.