When the hospital calim amount is exceed than the sum insured company taken a stand as sum insured is admissible claim amount and after deducting 10 % co pay company settle the claim of insured.  Against this insured have approached to Insurance Ombudsman , Pune.  After verification and personal hearing the ombudsman have given decision that 10 % co pay is to be deducted from Admissible claim amount and it the payable amount is exceeding the Sum Insured in that case company require to pay the amount up to sum insured and not after deductiong 10 % Co pay.  
AWARD NO. 10/PUN/A/HI/0444/2022-23 DT. 31ST OCTOBER 2022.

Good Decision 

Valid point sir