Ref : ER/PR/DG/orient.31
On a complaint filed by Consumer Education and Research Society (CERS),
and Anjali D. Divetiya, Ahmedabad, the Consumer Disputes Redressal
Forum, Ahmedabad City, has ordered ‘Oriental Insurance Company
Limited’ to pay her the surgery charge of Rs. 1,41.863 with 6
per cent interest from 18 December 1998 till payment and Rs. 1,500
as costs.
Anjali had undergone a surgery for both knees, costing her Rs.1,41,863.
She wanted to avail herself of the Mediclaim from Oriental Insurance
and claimed Rs.1,41,863 towards the cost of the operations. But the
company repudiated the claim on the grounds that the disease was pre-existing
and the complainant had concealed the facts at the time of taking
the Mediclaim policy. Anjali approached CERS for help.
CERS took up the matter with the Consumer Disputes Redressal Forum,
Ahmedabad. The Forum observed that there was no direct evidence to
prove that the complainant had concealed any information before taking
the Mediclaim policy. Oriental Insurance failed to prove that the
complainant had misled the company.
The Forum directed Oriental Insurance to pay Rs.1,41,863/- with 6
per cent interest and Rs.1500 as cost to Anjali.
Mr. V. C. Modi presided over the Forum, with Smt. J.Y. Shukla and
Smt. Hemkalaben Shah as Members.
Date : 25/08/2006
Pritee Shah
Place: Ahmedabad
Editor
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