• Posted by CERC India
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Oriental Insurance quits dodging, pays up mediclaim amount

Paurav N. Contractor from Ahmedabad had taken a mediclaim policy from Oriental Insurance Co. Ltd. for his wife Khushali and son Kahan for the sum of Rs. 5 lakh and Rs. 2.5 lakh respectively. During the validity period, Khushali fell seriously ill with systemic lupus ertyematousus. She died during treatment at Sterling Hospital on 29 August 2010. Contractor submitted a claim for the medical expenses which came to Rs. 5.41 lakh to the TPA MD India Healthcare Services enclosing all necessary documents.

He had a long wait ahead. Eventually, in March 2011 the TPA informed him that the claim was not payable as per a clause in the policy as the deceased had suffered from a genetic disorder. The treating doctor issued a certificate that the disease Khushali had suffered from was not necessarily a genetic disorder and the insurance company was asked to reconsider the claim. Contractor also approached CERS for help. Now, the company started employing delaying tactics to avoid its liability. It wrote a letter addressed to Khushali knowing full well that she was no more. Apart from this insensitivity, the company started harassing Contractor demanding various documents.

CERS and Contractor filed a complaint before the Consumer Forum. They submitted that the opponents, Oriental Insurance and the TPA, had kept the mediclaim pending since August 2010 and neither sanctioned nor rejected the claim rendering deficient services. The Forum ruled in favour of the complainant. In its order dated 27 November 2014, it directed the insurance company to give Contractor Rs. 5 lakh with 9% interest. In addition, Rs. 10,000 was to be paid as compensation for mental agony and harassment and Rs. 10,000 towards costs.

Builder to shell out Rs. 13.5 lakh for delay in handing over flat

Prashan and Sailee Dhotre, residents of Mumbai, purchased a flat in Thane costing Rs. 30 lakh. The agreement to sale was executed and registered on 1 March 2007 between the Dhotres and the developer Ganaraj Group. As per the agreement, possession was to be given by November 2009. When they had paid more than 95% of the amount, the Dhotres enquired about possession. However, the builder did not hand over the flat by the designated time. The Dhotres filed a complaint before the Maharashtra State Commission in 2010 since the developer did not respond to their repeated requests to hand over possession. No reason was given for the delay either.

The builder contended that the complaint was not maintainable as the complainants were not consumers under the provisions of Consumer Protection Act, 1986. The developer group, however, accepted that the Dhotres had paid the amount. In its order dated 28 November 2014, the Commission ruled in the favour of the complainants. The Commission said that no tangible reasons were revealed for the five-year delay. “The registered sale agreement says the flat was to be delivered on or before November 2009. The terms and conditions set out are certainly binding on the parties executing the agreement,” it said. The opponents had been deficient in service by not delivering vacant and peaceful possession of the flat, the Commission observed.

It directed the builder to pay a compensation of Rs. 13.50 lakh to the complainants – Rs. 9.84 lakh towards interest, Rs 3 lakh as compensation for mental agony and harassment and Rs. 50,000 towards costs. The builder was also told to hand over the flat within 45 days failing which Rs 1,000 per day would be payable to the complainants till the flat was handed over. The complainants are directed to pay balance amount of Rs. 39,400 to the builder.

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