National Insurance guilty of deficiency in service

Ahmedabad: The Consumer Disputes Redressal Forum, Ahmedabad city (Additional), has partly allowed a complaint filed by Consumer Education and Research Society(CERS), Ahmedabad, and Mr. Hemant Rami holding National Insurance Company Ltd.(Mumbai) liable for deficiency in service and unfair trade practice.

The Forum has ordered the company to pay Mr. Rami Rs. 2,38,805 towards his mediclaim policy with 6 per cent interest from 23 August 2001 till realisation and Rs 1,000 towards cost.

Mr. Rami and his wife had been mediclaim policyholders since 1992 with New India Assurance Company Ltd. and the duration of the policy was from 26 March 1992 to 25 March 2001. On the expiry of the policy, they took another mediclaim policy from 4 April 2001 to 3 April 2002 from National Insurance, Mumbai, through Winner Capital and Credit Ltd. Mumbai, for which they paid Rs. 77,000 to Robins Impex Ltd., agent of National Insurance.

Mr.Rami met with a severe accident on 17 May 2001 for which he was hospitalised for 20 days. His treatment expenses reached Rs. 2,38,805. On discharge , he filed a claim for hospitalisation on 23 August 2001. He was shocked when National Insurance, through its correspondence to Winner Capital & Credit Ltd. dated 18 September 2001, mentioned that his claim had been rejected.

The company explained the claim rejection saying that Mr. Rami suffered from diabetes mellitus, haemolytic anaemia, hypothyroidism, etc. and these ailments were present when he had applied for the policy. But the company missed the fact that Mr. Rami had claimed for hospitalisation expenses incurred because of an accident and not for pre-existing diseases.

The Verdict
The Forum partly allowed the complaint and directed National Insurance to pay Rs. 2,38,805 under the mediclaim policy with 6 per cent interest from 23 August 2001 till realisation. National Insurance was also directed to pay Mr. Rami Rs 1,000 towards cost. The complaints against Robins Impex Ltd.,Ahmedabad, and Winner Capital & Credit Ltd. were dismissed.

The Forum comprised Mr. V. C. Modi, President and Ms. J. Y. Shukla, Member. Ms. Neeta Shah, Advocate, pleaded for CERS and Mr. Hemant Rami, and Ms. Nayana Shah, Advocate, for National Insurance, and Mr. Mihir Lakhiya, Advocate, for Winner Capital & Credit Ltd.

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