Skip to main content

Insurance companies can’t make unilateral changes in mediclaim policies: Forum

In two separate cases, a consumer forum has held that unilateral changes made in a mediclaim policy by the insurance company amounted to deficiency in service. In both cases the forum relied on a Supreme Court judgment which observed that renewal of an insurance policy means repetition of the original policy.

"In common parlance, by renewal, the old policy is revived and it is sort of a substitution of obligations under the old policy unless such policy provides otherwise. It may be that on renewal, a new contract comes into being, but the said contract is on the same terms as of the original policy," the SC had said.

The forum directed The New India Assurance Company Ltd to reimburse Rs 87,186 and pay compensation of Rs 27,000, to Dadar resident Soli Modi. The firm had sanctioned Rs 62,814, instead of the assured sum of Rs 1.5 lakh that Modi had incurred in a hernia surgery in 2012.

In the complaint filed before the Central Mumbai District Consumer Disputes Redressal Forum, Soli said on perusing the reasons for sanctioning only a part amount of the claim, it was noticed that the deductions were made on account of changes in the policy terms that were made without his knowledge.

In the second instance, a Dahisar woman who had undergone a hysterectomy in 2011, was sanctioned Rs 22,500 instead of the Rs 1.2 lakh incurred as charges for the surgery and tests. On probing the reason for the part rejection, she learnt that her policy was changed from an Individual policy to a Janta policy without her consent.

"The insurance firm and third-party administrator have acted arbitrarily and tried to modify the terms...of the earlier policies issued to her husband. The firm had indulged in unfair trade practices by issuing Janta Policy and under the garb of that policy curtailed the rights of the complainant which were available to her...under the old policies," the forum said. The woman will get Rs 20,000 compensation and Rs 42,624 reimbursement.

Article referred: http://timesofindia.indiatimes.com/City/Mumbai/Insurance-companies-cant-make-unilateral-changes-in-mediclaim-policies-Forum/articleshow/41545817.cms

Comments

Post a Comment

Most viewed this month

Merits and the terms of contract are irrelevant for invoking of the bank guarantees

In Sabarkantha Annuity Pvt. Ltd. Vs. NHAI and Ors, the Petitioner filed before the Delhi High Court  petition under Section 9 of the Arbitration and Conciliation (Amendment) Act, 2015 with a prayer that, Respondents be restrained from acting upon the letter dated 15th September, 2017 or from invoking the Bid securities of the Petitioner to the tune of Rs. 10.93 Crores and also restraining the banks from honouring the invocation of said bank guarantees on behalf of Respondent No. 1 acting in terms of letter dated 3rd November, 2007. Petitioner has relied upon Clauses Nos. 9.1.1, 9.1.2 and 4.3 of the agreement dated 28th April, 2017 entered into between the parties to say the claim for damages since is not a claim for a sum presently due and payable and the respondent would be entitled to damages only on proof of loss, per Clause 4.3 of the agreement and hence is not entitle to the entire sum of bid security.  The Court found that Clause No. 9.1.2 speaks of an exclusiv...
Post a Comment
Read more

Right of pre-emption under West Bengal Land Reform Act

In Rabindra Nath Kundu & Anr vs Sudhir Hira, Bijoy Krishna Hira being the owner in the suit plot, gifted to Santosh Kumar Hira demarcated 11 decimals of land vide deed of gift dated 27.4.2004 and the latter sold 9 decimals out of 11 decimals of land to Sudhir Hira the preemptor/opposite party no. 1 and well demarcated 1.65 decimals of land in the said plot along with several other plots were sold, transferred and conveyed to the preemptees/petitioners herein by a registered deed of sale dated 10.8.2010, the subject matter of preemption. It is argued on behalf of the preemptees that  the present opposite party no. 1/preemptor Sudhir Hira has no relationship of co-sharership with Santosh Kumar Hira opposite party no. 2 as the demarcated portion of land has been purchased. It is settled principle of law that partial preemption is not permissible and this was what the view adopted by this Hon'ble High Court is Surendra Vs. Abhimannu reported in (1980) 1 Cal LJ 135 whe...
Post a Comment
Read more

CBI has no jurisdiction to probe affairs of medical college:HC

The Madras High Court has quashed charges against administrators of a medical college and dismissed CBI's petitions opposing discharge of officials of two other medical colleges, saying the investigation agency, or any other external agency for that matter, has no jurisdiction to probe the affairs of a medical college. Quashing the charges against the administrators of a medical college and dismissing CBI's petitions opposing the discharge of officials of two other medical colleges, Justice Aruna Jagadeesan said "contravention of rules and regulations may be an offence against the statute but is not a crime. There is no room or jurisdiction for any external agency to investigate the affairs of any medical institution coming within the purview of the Medical Council of India." In identical set of orders, all delivered on August 6, Justice Jagadeesan said "the shortfall in faculties and submissions of fake/forged documents would only disentitle the institution...
Post a Comment
Read more