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Times of India | Insurance co told to pay hosp expenses over service fault

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The North Goa District Consumer Dispute Redressal Commission ordered ICICI Lombard to reimburse Porvorim resident Ayesha Nasim for two hospitalisations (Rs 13,657 for 20 January 2025 and Rs 13,209 for 8 February 2025), and to pay a Rs 25,000 compensation with 5% interest for deficiency of service; Nasim, who fell ill with severe stomach pain, vomiting, diarrhoea and dehydration and was treated at RG Stone Hospital, filed a claim under her 2008 health policy but the insurer denied it, citing a required co‑pay that she had never been asked to make, and later claiming the claim was not “medically necessary” and that she had not raised any discrepancy. The commission found the insurer’s defence vague, its assertion of a co‑pay unsubstantiated, and ruled the company liable for failing to honour the claim.

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ICICI Lombard Ordered to Compensate Hospital Expenses After Claim Rejection | Goa News - The Times of India

The North Goa District Consumer Dispute Redressal Commission has mandated ICICI Lombard to compensate a Porvorim resident for hospital expenses and additional damages following a rejected insurance claim. The case highlights deficiencies in service and insurance policy communication.

The Times of India