Insurance Company asked to pay claim with interest

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Ahmedabad, Oct 3 (UNI) The Consumer Disputes Redressal Forum has ordered the Oriental Insurance Company to honour the claim of its consumer and pay him Rs 18,000 with nine per cent compound interest, besides Rs.5,000 towards the cost of the complaint.

The case was filed by Consumer Education and Research Soceity (CERS) on behalf of a personal accident policy holder Gautam K Shah.

Complainant Gautam had taken a personal accident policy from The Oriental Insurance Company.

Some time back a scooter hit Gautam and he was admitted to a hospital with serious foot injuries for which he had to be operated on.

However, 15 days after his discharge from hospital, he diagnosed the existence of gangrene -- a complication of decay of body tissues.

Doctors advised him to go in for another surgery and get the second finger on his right foot amputated.

After the treatment, Gautam submitted his claim papers but to his surprise, the insurance company repudiated the claim on the grounds that the operation of the gangrene on the foot was not due to the accident but it was due to diabetes that Gautam had before he took the policy (read pre-existing).

An aggrieved Gautam who had been holding the accident policy for the last 18 years and renewing it every year, complained to the Forum.

The Forum passed a verdict in favour of Gautam and held that the insurers failed to prove with evidence that the operation of Gautam's foot was due to diabetes and not due to road accident.

UNI PVN SSS AG2118

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