Ref. : E&R/pressrel/NICLM.23/KG
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.
Date : 21/08/2007
Pritee Shah
Place: Ahmedabad
Editor
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