The District Consumer Grievance Redressal Commission, Sindhudurg, has directed New India Assurance Company Limited to pay Rs 72,220 with 10.9 per cent interest, along with Rs 35,000 towards mental distress and litigation costs, to a retired police sub-inspector who was denied full medical claim reimbursement.
The order was passed in a complaint filed by Vilas Harishchandra Sawant, 63, a retired police sub-inspector from the Mumbai Police, and a resident of Kankavali, Sindhudurg. The case, filed on December 15, 2023, was adjudicated by Commission President Indumati Shreyas Malushte and Member Yogesh Yashwant Khadilkar.
Sawant, who retired in February 2017, had a group mediclaim policy valid from July 25, 2022, to July 24, 2023. He was admitted to Fortis Hospital, Mulund, on November 29, 2022, and discharged on December 3, 2022, incurring total expenses of Rs 2.31 lakh. However, the insurer sanctioned only R97,414, prompting him to approach the Commission seeking reimbursement of the balance amount.
Despite being served notice on December 22, 2023, the insurer failed to file a reply within the stipulated 45 days, resulting in an ex parte order on March 13, 2024. The Commission found that the company had made unjustified deductions under heads like investigation, nursing, and consultant charges without any explanation or supporting documents.
Citing Rules 3.0 and 4.4.1 of the New India Flexi Floater Group Mediclaim Policy, the bench held that the insurer wrongly deducted Rs 72,220, amounting to a deficiency in service under Sections 2(7) and 2(42) of the Consumer Protection Act, 2019.
In its order dated September 11, 2025, the Commission directed the insurer to pay Rs 72,220 with 10.9 per cent annual interest from January 24, 2023, and an additional Rs 35,000 towards compensation and litigation costs within 45 days. Failure to comply will attract 10.6 per cent interest and possible legal action under Sections 71 and 72 of the Act.
From the force to the fight
Sawant, who joined the Mumbai Police in 1983 and retired as a sub-inspector from Jogeshwari Police Station in 2017, said he never imagined he would have to fight for his medical rights after decades of service. After fracturing his leg in his hometown, he was treated at Fortis Hospital, Mumbai, where the bill came to Rs 2.31 lakh. “I submitted all the required documents and receipts, yet they deducted amounts arbitrarily without explanation,” he said.
He added that a previous hospitalisation in October 2022 at Nagvekar Hospital, Kankavali, cost him another Rs 37,000, but the insurer again refused to clear the full amount. “I somehow managed to pay the hospital bill and get discharged. Despite repeated calls and letters, the company ignored me,” Sawant said. “I had no choice but to approach the consumer court.”
Sawant filed a complaint under Section 35 of the Consumer Protection Act, seeking reimbursement and damages for mental harassment. The Commission ruled in his favour, calling the deductions “arbitrary and unjustified.” “I am happy with the court’s decision,” he said after the verdict. “I fought not just for myself, but so others like me won’t suffer the same treatment.”
