Feb.18: SETTLED IN COURT
- Posted by CERC India
- Posted in February
Court orders United Insurance to pay surgeon’s feesÂ
Deepa Sonpal had a mediclaim policy from United Insurance Company Ltd. for a sum insured of Rs. 2.75 lakh. In 2012, she underwent a hysterectomy at Shrey Hospital. The surgeon, Dr. Mukesh Bavishi, asked her to pay his fee of Rs. 1 lakh separately. Deepa submitted a claim for Rs. 1.19 lakh. To her shock, the TPA only sanctioned Rs. 14,571!
As per the policy terms, Deepa was entitled to payment of 25% of Rs. 2.75 lakh i.e. Rs. 68,750. Instead, the insurer had arbitrarily deducted Rs. 54,179. Deepa noticed that the main expense – surgeon’s fees – had not been sanctioned on the grounds that it was not part of the hospital bill. She approached Consumer Education and Research Society (CERS), Ahmedabad for help. After five months of persuasion by CERS, the hospital issued a certificate mentioning all the expenses.
Deepa showed the insurance company the certificate but it said that payment could be made only against a bill. She was being penalized for no fault of hers – for agreeing to pay the surgeon separately. She wondered: Was there an unholy nexus between the hospital and insurance company? CERS and Deepa filed a complaint in the District Forum.
Verdict
After hearing both the parties, the Forum ruled in favour of the complainant and directed the insurance company to pay her Rs. 54,179 with 9% interest, Rs. 5,000 as compensation for mental harassment and Rs. 3,000 towards litigation costs.
Point of law
An insurance company cannot decline to pay surgeon’s fees which are an integral part of hospital expenses.
[Source: The order of the Consumer Disputes Redressal Forum, Ahmedabad dated 28 August 2017 on Consumer Complaint no. 637/2015]
Parle told to compensate buyer for worms in biscuit packet
Mohammad Sheikh purchased a packet of Parle-G biscuits for Rs. 25 from a shop. He was shocked to find worms in the packet. Mohammad complained to the Joint Commissioner, Food and Drugs Administration, and the sample was tested. The laboratory report said that the biscuit packet had insects, larve and cobwebs. As such, it was unsafe for consumption as per the Food Safety and Standards Act, 2006.
The date of packaging was January 2015 but the expiry date was not visible. This amounted to clear deficiency in service on the part of the opposite parties causing mental agony to the complainant and his family.
Verdict
Since the respondents – the company and the retailer – failed to appear for the proceedings, the case was decided ex-parte. The Forum observed that they had not challenged the evidence submitted by the complainant. It asked them to pay him a compensation of Rs. 35,000 – Rs 25,000 for causing mental agony and Rs 10,000 towards litigation fees.
Point of law
A packaged food manufacturing company is required to clearly display the expiry date on the packet. A retailer is liable for selling a product that is unsafe for consumption.
[Source: The order of the Thane Additional District Consumer Redressal Forum dated 14 September 2017 on Complaint no. 60/2016]
