Forum orders New India Assurance to pay Rs 2.38 lakh for deficiency

Ahmedabad, Aug 21 (UNI) The Consumer Disputes Redressal Forum, Ahmedabad (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 August 23, 2001, till realisation and Rs 1,000 towards cost, a CERC release said here today.

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 March 26, 1992, to March 25, 2001.

On the expiry of the policy, they took another mediclaim policy from April 4, 2001, to April 3, 2002, from National Insurance, Mumbai, through Winner Capital and Credit Ltd, Mumbai for which they had paid Rs 77,000 to Robins Impex Ltd, an agent of National Insurance.

Later, Mr Rami met with a severe accident on May 17, 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 August 23, 2001. He was shocked when National Insurance, through its correspondence to Winner Capital&Credit Ltd dated September 18, 2001, mentioned that his claim had been rejected.

The company explained the claim rejection saying that Mr Rami suffered from diabetes mellitus, haemolytic anaemia and hypothyroidism 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 Forum directed National Insurance to pay Rs 2,38,805 under the mediclaim policy with 6 per cent interest from August 23, 2001, till realisation to the claimant. National Insurance was also directed to pay Mr Rami Rs 1,000 towards cost.

It however dismissed the complaints against Robins Impex Ltd, Ahmedabad and Winner Capital&Credit Ltd.

UNI