Skip to main content

Insurance firm pulled up by consumer forum for arbitrary decision

The South Mumbai district consumer dispute redressal forum on Monday pulled up the New India Assurance company guilty of arbitrarily deducting a claim made by one of its Versova-based consumers who had undergone a cataract operation in October 2009.

What did the fine amount to?
The forum directed the firm to pay back the total expense occurred to the consumer, which is Rs72,606, along with 6% interest on the amount from November 2009 onwards. The forum also directed the firm to pay an additional Rs15,000 and Rs5000 towards the complainant's mental agony and litigation cost, respectively.

What had happened to the consumer?
As per the forum's order copy, Prem Padma had, in 1991, purchased a mediclaim policy which had a claim cover of Rs3 lakh, and which was active till the year 2010.
In 2009, Padma started realizing a problem in her left eye, and thus sought medical opinion from an ophthalmologist, who asked her to undergo a cataract operation, which was done in October 2009.

What was the discrepancy?
After getting operated, Padma immediately sought for her medical claim of Rs72,606 from the firm on an immediate basis. However, in December 2009, the firm issued her a cheque of Rs46,106 and refused to issue the remaining amount of Rs26,500.
Despite Padma asking for the remaining amount to be cleared, it was not done. Thus, she refused to accept the previously disbursed amount and returned the cheque to the firm. Aggrieved by the firm's attitude, Padma filed a complaint at the firm in December 2012.

What was the firm's defense?
After going through the complaint, the forum asked the firm to file a reply. The firm then claimed that as per their rule book, the maximum amount which one needs for cataract surgery is Rs 40,000. However, in Padma's case, they had issued an amount of Rs 46,106. Thus claiming that they did not fail in providing service to their consumer.

Arbitrary attitude
The forum went through the arguments made by the complainant and the firm, and held that the rule upon which the firm had relied to deduct the amount, was not produced before the forum. "This clearly shows that the firm has acted arbitrarily while deducting the claim lodged by the complainant," the forum's order copy read.

 Article referred: http://www.dnaindia.com/mumbai/report-government-insurance-firm-pulled-up-by-consumer-forum-2034012

Comments

Post a Comment

Most viewed this month

The recovery of vehicles by the financier not an offence - SC

Special Leave Petition (Crl.) No. 8907  of 2009 Anup Sarmah (Petitioner) Vs Bhola Nath Sharma & Ors.(Respondents) The petitioner submitted that  respondents-financer had forcibly taken away the vehicle financed by them and  illegally deprived the petitioner from its lawful possession  and  thus,  committed  a crime. The complaint filed by the petitioner had been  entertained  by  the Judicial Magistrate (Ist Class), Gauhati (Assam) in Complaint Case  No.  608 of 2009, even directing the interim custody of the vehicle (Maruti  Zen)  be given to the petitioner vide order dated  17.3.2009.  The respondent on approaching the Guwahati High  Court against this order, the hon'ble court squashed the criminal  proceedings  pending   before  the  learned Magistrate. After hearing both sides, the Hon'ble Supreme Court decided on 30th...
7 comments
Read more

When debt is bona fide disputed and the defence is a substantial one, the court will not wind up the company

In SHITAL FIBERS LTD.  vs  INDIAN ACRYLICS LIMITED, as per the respondent, appellant had made a payment of Rs.61,83,218/­. However, there was an outstanding balance of Rs.8,92,723/­ as on 28.7.2008. Since despite repeated requests, balance amount was not paid, the respondent issued a statutory notice to the appellant. The same was duly responded to. As the payment was not made despite notice being duly served on the appellant, the respondent filed the aforesaid Company Petition seeking winding up of the present appellant for its inability to pay admitted debts. The learned Company Judge vide order dated 28.9.2015 admitted the Company Petition. However, while doing so, the learned Company Judge observed, that since the appellant was an on­going concern, an opportunity should be granted to it to settle the accounts with the respondent by 31.12.2015. Only in case of failure of the settlement, the citation was directed to be published. On appeal, the Division Bench of the High Cou...
Post a Comment
Read more

Abusing in-laws a ground for divorce: SC

Abusing in-laws and not allowing them to reside in the matrimonial home by a woman amounts to cruelty to her spouse, ground enough for grant of divorce, the Supreme Court has ruled while allowing an NRI's plea for legal separation from his wife. A bench of Justices Vikaramajit Sen and A M Sapre said such incidents could not be termed as "wear and tear" of family life as held by Madras High Court which had said that a couple must be prepared to face such situations in matrimonial relationship. The NRI had filed a divorce petition alleging that his wife was abusive to his family members and did not allow his parents and siblings to stay in his house when they visited the US. Referring to an incident, the husband told the court that his wife had once locked him and his sister out of the house and abused them saying they belonged to a 'prostitute family'. She refused to allow her sister-in-law to enter the house and even lodged a police complaint against her hu...
4 comments
Read more