December-19: Settled in Court
Court orders LIC to pay Rs. 48 lakh for death claim
Hetalkumar Patel took nine policies from LIC. Within two years he died due to heart attack. LIC repudiated the claims filed by his family saying that Patel was being treated for depression and he had not disclosed his ailment at the time of taking policies.
Payment for seven claims was awarded by the Nadiad Forum. For two policies of higher amount, the family went to the State commission. LIC also challenged the lower courtâ€™s orders at the Commission.
Patelâ€™s advocate cited various orders passed by the Supreme Court and the National Commission to show that insurance companies were directed to pay death claims in which cause of death and the pre-existing ailments had no nexus. The court observed that it was very clear that Patel was suffering from major depression and he died due to heart attack. There was no co-relation between depression and the cause of death and hence LIC could not the repudiate claims on the ground that he was severely depressed.Â
The State Commission ordered LIC to pay Rs 47.90 lakh with 7.5% interest for two policies, with Rs. 10,000 for mental harassment and legal costs. It also upheld the lower courtâ€™s order for payment of the other seven claims.Â
Point of LawÂ
Insurance company cannot deny life insurance claim if there is no nexus between a pre-existing disease and the cause of death
[Source: The order of the Gujarat State Consumer Disputes Redressal Commission, Ahmedabad, dated 25 January 2019 on Complaint Nos. 46-47/2012 and Appeal Nos. 3402-3408/2012]Â
Patient gets compensation of Rs. 3 Lakhs on being fleeced by doctor
Dinesh Joshi was taking treatment for fissures from Dr Geeta Jindal. He was admitted into the hospital. Six daysâ€™ hospitalization bill came to Rs 36,450. Joshi refused to deposit more money, so he was discharged.
In the bill issued by Dr Jindal, he was charged Rs 1,850 for tests which would cost only Rs 250 in any laboratory. Also, Rs 12,500 was charged for ICU and Rs 11,200 for disposable surgical items. Joshi complained to the Director General of Health Services, Haryana. A medical board was formed which exonerated Dr Jindal.
Joshi approached the district forum. The forum, too, exonerated Dr Jindal. The Haryana State Commission also dismissed Joshiâ€™s appeal. He then filed a revision petition.
The National Commission observed the hospital record showed Joshi was in an AC room, but the billing for ICU charges was done. It also noted there was no justification for the billing for surgical disposables as per noting on the discharge card.Â
Â The Commission concluded that Dr Jindal was not only negligent in treatment, but had also wrongly billed charges and therefore indicted her for unfair trade practice through wrong billing. It ordered Dr. Jindal to pay Rs. 3 lakh as compensation towards medical expenses, inflated billing, and compensation for mental agony and pain suffered to be paid within four weeks.Â
Point of LawÂ
A treating doctor is liable to pay compensation for negligence in treatment as well as for wrong and inflated billing.
[Source: The order of the National Consumer Disputes Redressal Commission, New Delhi, dated 25 January 2019 on Revision Petition No. 2381 of 2016]