Dec.17: SETTLED IN COURT
- Posted by CERC India
- Posted in December
National Insurance made to pay full amount to cancer survivor
Meena Dave held a policy with National Insurance Company Ltd. The sum insured was Rs. 3 lakh. In 2011, she was diagnosed with breast cancer and underwent an operation. Since Rs. 50,000 was approved by the insurance company under the cashless provision, the balance of Rs. 42,450 was paid to the hospital by Meena. Thereafter, she had to pay Rs. 19,227 as post-hospitalisation expenses.
A claim for Rs. 61,677 was lodged with the insurance company. To her shock and distress, the insurance company allowed only Rs. 19,227. The amount of Rs. 42,450 was rejected on the grounds that, as per the PPN (preferred provider network) contract signed between the hospital and the insurance company by the TPA, the maximum payable to the hospital with respect to the operation had already been paid.
Aggrieved, she contacted Consumer Education and Research Society (CERS), Ahmedabad for help. The terms and conditions of the policy nowhere mentioned a maximum amount payable to the hospital. Further, the consumer had no knowledge of the PPN contract. So, a complaint was filed.
 Verdict
The Forum ruled in favour of the complainant and directed the insurance company to pay Rs. 42,450 to Meena with 9% interest. It also awarded Rs. 3,000 as compensation for mental harassment and Rs. 2,000 towards litigation costs.
Point of law
An insurance company cannot partly deny a claim citing terms that the consumer is not informed about.
[Source: The order of the Consumer Disputes Redressal Forum, Ahmedabad dated 30 June 2017 on Complaint no. 943/2013]
Oil firm is responsible for defective LPG cylinder
Ravindra Rao lost his father, mother and daughter due to a mishap caused by leakage of an LPG cylinder in 2008. His wife was seriously injured and his house was damaged. While his father was fixing the regulator on the new cylinder, the pin in the neck of the cylinder had slipped leading to gas leakage. A fire broke out when the electric light was switched on.
A grieving Ravindra filed a consumer complaint against Indian Oil Corporation (IOC) and its distributor alleging negligence. The company denied these allegations and tried to put the blame on the consumer saying that the cylinder and the valve pin had been mishandled.
However, the Forum found the oil giant and the dealer jointly liable and asked them to pay Rs. 10.5 lakh along with 9% interest to Ravindra plus Rs. 5,000 for litigation expenses. IOC challenged the order before the Karnataka State Commission. On dismissal, it approached the National Commission.
Verdict
The National Commission observed that unless there is concrete evidence to establish that the consumer had been negligent, it is to be inferred that the incident occurred due to some defect in the cylinder. It dismissed the appeal and upheld the earlier verdicts holding the company and dealer guilty of deficiency in service.
Point of law
A company needs to prove that the consumer has been negligent before shirking responsibility for a mishap.
[Source: The order of the National Consumer Disputes Redressal Commission, New Delhi dated 24 January 2017 on Revision petition no. 2374/2014]
