Skip to main content

When in doubt, pay in full, forum tells insurer

If there is any ambiguity in the terms of an insurance policy, the benefit should go to the consumer, a consumer forum here has ruled, asking an insurance company to pay the entire medical claim amount to a man who underwent a surgery.

Manicklal Rathi, 69, took a mediclaim policy from National Insurance Company Ltd at an annual premium of Rs 28,000 under which he was covered up to a medical expenditure of Rs 4 lakh. Rathi, who had a policy for Rs 2 lakh since 2000, enhanced the cover to Rs 4 lakh in February 2010. Two months later, he underwent a knee replacement surgery, incurring an expenditure of Rs 2.69 lakh.

However, the company did not settle the full amount and withheld Rs 79,131. The company did not respond to his representations, prompting him to approach the Consumer Protection Council, Tamil Nadu, which filed a complaint on his behalf at the district consumer disputes redressal forum, Chennai (North).

In its reply, the company said according to the terms of the policy, it could not reimburse the entire amount during the initial four years of the policy period. Further, it argued, Rathi had "already submitted a discharge voucher" for the sum he received and hence cannot stake claim for more.

Rathi's counsel S Pushpavanam, citing a Supreme Court verdict, said executing a discharge voucher cannot absolve an insurance company of its liability. Such a voucher could have been obtained through fraud or misrepresentation, he said. The company had provided "highly ambiguous" terms and conditions and there was no documentary evidence to prove that while issuing the policy, it had explained the terms to Rathi, Pushpavanam said.

Quashing the company's arguments as "unsustainable" recently, the bench comprising president R Mohandoss and member T Kalaiyarasi found it guilty of negligence and deficiency in services. It directed the company to reimburse Rs 79,131 along with an interest of 9%. The forum also slapped a fine of Rs 5,000 on the company for deficiency in services and awarded Rathi another Rs 2,000 as case costs.

 Article referred: http://timesofindia.indiatimes.com/india/When-in-doubt-pay-in-full-forum-tells-insurer/articleshow/31810848.cms

Comments

Post a Comment

Most viewed this month

Appellate authorities under Special Statutes cannot be asked to condone delay

Madras High Court in R.Gowrishankar vs. The Commissioner of Service Tax has held that Appellate authorities cannot be asked to condone the delay, beyond the extended period of limitation A Division Bench comprising of Justices S. Manikumar and D. Krishnakumar, made this observation while considering an appeal filed against Single Bench order declining to set aside the order made in the condone delay petition filed by the petitioner to condone 223 days in filing the appeal before the Commissioner of Service Tax (Appeals). Article referred: http://www.livelaw.in/appellate-authorities-special-statutes-cannot-asked-condone-delay-beyond-extended-period-limitation-madras-hc/
Post a Comment
Read more

'Seize assets to pay damages to accident victim'

Her story might be an inspiration for the physically challenged but justice has remained elusive for her. In 2008, a bus accident left research engineer S Thenmozhi, 30, paraplegic. In April 2013, the motor accident claims tribunal directed the Tamil Nadu State Transport Corporation (TNSTC) to provide her a compensation of 57.9 lakh. However, TNSTC refused to budge and on Tuesday a city court ordered attaching of movable assets of the transport corporation. Thenmozhi was employed in C-DOT, a telecom technology development centre in Bangalore. On July 21, 2008, she was coming to Chennai in a private bus. Around 2am, the bus had a flat tyre and the driver parked it on the left side of the road near Pallikonda in Vellore district on the Bangalore-Chennai highway. While the tyre was being changed, a TNSTC bus of Dharmapuri division hit the stationary bus. The rear part of the bus was smashed and passengers were injured. Thenmozhi who had a seat at the back of the bus suffered...
Post a Comment
Read more

Mumbai ITAT rules income of offshore discretionary trust is subject to tax in India

The Mumbai Income Tax Appellate Tribunal (ITAT) has recently determined the following issue in the affirmative in the case of Manoj Dhupelia: Should the income of an offshore discretionary trust be subject to tax in India, if no distributions have been made to beneficiaries in India? The question arose from appeals filed by individual beneficiaries in relation to a Lichtenstein-based trust, the Ambrunova Trust and Merlyn Management SA (the Trust) with the ITAT. It is important to note that the individuals in this case were amongst those first identified by the Government of India (GOI) as holding undeclared bank accounts in Lichtenstein. The ITAT ruling raises the following issues: Taxation of Trust Corpus: ITAT classified the corpus of the trust as "undisclosed income" and declared it taxable in the hands of the beneficiaries. Taxation of Undistributed Income: ITAT refused to draw a distinction between the corpus and undistributed income from the trust and declared i...
Post a Comment
Read more