Aug.17: SETTLED IN COURT
- Posted by CERC India
- Posted in August
No touching accident vehicle before inspection
Ghanshyam Maurya’s Escorts tractor met with an accident during the warranty period. At the authorised workshop, he instructed that the tractor be opened up to get a repair estimate. The insurance company was also intimated. It refused to honour the claim of Rs. 25,000 – the estimated cost of repair – as the tractor had been touched before the surveyor could inspect it.
Ghanshyam filed a complaint before the District Forum saying the tractor suffered from various manufacturing defects. He sought a replacement and compensation for harassment.Â
The dealer and manufacturer pointed out that the company was required to remove manufacturing defects, if any, by repairing or replacing defective components during the warranty period.
The Forum allowed the complaint and ordered a replacement of the tractor, or alternatively, refund of its price of Rs. 1,71,980, along with interest, compensation and costs. This order was challenged before the Uttar Pradesh State Commission, but the appeal was dismissed.
Verdict
The dealer then approached the The National Commission which observed that Ghanshyam had not produced any evidence to establish manufacturing defects in the tractor. It concluded that he had made false allegations about manufacturing defects as the insurance company had rejected his claim. Accordingly, the National Commission set aside the orders of the lower fora and dismissed the complaint.
Point of law
In an accident case, a consumer must not touch the vehicle before it is inspected by the surveyor. He should keep the insurance company’s agent’s phone number handy. He should contact agent/surveyor for instructions.
Source: The order of the National Consumer Disputes Redressal Commission, New Delhi dated 2 November 2016 on Revision Petition No. 488 of 2016
New India denies claim on illogical grounds
Dinesh C. Shah purchased a mediclaim policy from New India Assurance Co. Ltd. for Rs. 1 lakh. During the validity period of the policy he was admitted to Sterling Hospital in Ahmedabad for an infection in the spinal cord and operated on. The bill came to Rs. 1,18.623. Dinesh submitted his claim to the third party administrator (TPA). The insurer instead of clearing the entire bill of Rs. 1 lakh, extended cashless facility only for Rs. 50,000.
Dinesh took up the matter with the TPA but there was no response. Distressed, he approached Consumer Education and Research Society (CERS), Ahmedabad. When the opposite party failed to respond to a legal notice, a complaint was lodged with the District Forum. Dinesh came to know that the insurance company had denied the Rs. 50,000 reimbursement on the grounds of pre-existing disease. It had claimed that Dinesh had the policy from 29 July 2007 to 28 July 2008Â for Rs. 50,000. On renewal of the policy for the next year, he had increased the sum assured to Rs. 1 lakh. The MRI report indicating spinal TB was dated 26 November 2008. Dinesh had renewed the policy for a higher sum since he knew about the ailment, the company alleged. Hence, the company was only liable to pay Rs. 50,000.
The Forum ordered the insurance company to pay Rs. 50,000 with 8% interest, Rs. 3,000 towards compensation for mental agony and harassment and Rs. 2,000 towards costs of litigation. The insurance company appealed to the State Commission.Â
Verdict
The State Commission dismissed the appeal and upheld the Forum’s verdict. It directed New India Assurance to pay the complainant Rs. 5,000 towards litigation costs.Â
Point of law
When an insurance company settles only half the claim on the grounds of pre-existing disease, it is illogical.
Source: The order of the Consumer Disputes Redressal Forum, Ahmedabad dated 18 January 2017 on Appeal No. 1928/2013
