Ahmedabad, Oct 6 (UNI) The Consumer Disputes Redressal Forum, Ahmedabad District (Rural), has ordered United India Insurance Company to pay compensation of over 5,000 US dollars to one Smruti Bhasker Patel in an overseas medical claim policy.
The Forum, while hearing the case filed by Consumer Education and Research Society (CERS) and Ms Patel, a resident of the city, ordered the United India Insurance Company Limited (UIIC) to pay Smruti 5,041.65 US dollars compensation for gross negligence, deficiency in service and unfair trade practice case.
The Forum ordered the company to pay Smruti 5,041.65 compensation, i.e 3,632.15 US dollars plus 1,409.50 US dollars with nine per cent cumulative interest, from the date of the complaint until recovery.
The amount should be paid in Indian rupees as per the exchange rate prevailing on the date of the complaint.
The Forum also ordered the company to pay her Rs 10,000 for tension, hardship and inconvenience suffered by her.
Smruti had paid a premium of Rs 3,281 and taken out an overseas mediclaim policy from United India Insurance on April 22, 2002, covering the period from April 27 to June 12, 2002. She renewed the policy from June 12 to June 25, and again up to July 10, 2002, for which she paid the premiums. The policy thus covered her from April 27 to July 10, 2002.
During her stay in the US, Smruti suffered from acidity-related laryngeal lesion illness and was treated at the John Hopkins Hospital on July 1 and 2, 2002, as an outpatient and on the second day underwent a surgery. She paid 3,632.15 US dollars towards the charges for surgery and subsequent hospitalisation up to July 9, 2002.
She submitted her claim form with the original documents to Mercury International Assistance and Claims Ltd, the UK-based agent of United India Insurance. She also sent 100 US dollars along with the claim form towards the amount deductible as per the policy.
Later, she received three more bills from John Hopkins Hospital and forwarded them to Mercury International for direct payment.
Mercury International returned some of the documents along with an undated letter to Smruti and asked for some other documents. As she had already sent the originals, she sent copies of the documents on August 23, 2002. After more futile correspondence between Smruti, United India Insurance and Mercury International, she sought the intervention of CERS which, in turn, wrote to the chairman of United India Insurance requesting an early settlement of the claim.
She and CERS submitted that, even after two years, the insurance company had shown clear negligence and that it had neither settled nor repudiated the claim within 30 days of receipt of the claim, as per the IRDA Regulation 8(3) 2002. But the fact that the insurance company had asked Mercury International to arrange for releasing the payment soon indicated that it had acknowledged the claim but was not settling it.
The insurance company argued, among other things, that it had not repudiated the claim and that the complaint was not maintainable as the Forum had earlier dismissed it, and that the complainants had not challenged that order.