Consumer forum orders Oriental Insurance Company to settle claim

Nashik: The Nashik District Consumer Disputes Redressal Forum has ordered the Oriental Insurance Company to settle a claim of Rs 5 lakh that was raised by a city resident following the death of his mother due to injury in 2017.

Complainant Dheeraj Sevakramani had insured his family members in 2009 and renewed their policies regularly. On July 17, 2017, Sevakramani’s mother was admitted to a hospital because of illness. When she was about to be discharged on July 31, she suffered a fall in the bathroom of the hospital and on October 21, succumbed to head injuries that had also left her paralysed.

Sevakramani filed for a claim of Rs 5 lakh from Oriental Insurance. But the company rejected the death claim on December 20, 2017, on the grounds that the death was caused not by accident, but illness. The company also claimed that Sevakramani had concealed certain details related to his mother’s illness at the time of getting the policy.

“The mother of the complainant was suffering from several diseases which have been mentioned in the death certificated issued for the deceased. Besides, the certificate also mentions these diseases as the cause of death along with the fall. This violates the terms and conditions of the insurance,” company counsel SS Purnapatre had claimed. But counsel for the complainant, P R Chandrakor, pointed out that hospital had mentioned several diseases as the ‘antecedent cause’ in the ‘cause of death certificate’ but at the same time, the ‘immediate cause of death’ was attributed to ‘Cerebrovascular Accident’ which meant injury to brain.

The three-member redressal forum, headed by president Milind Sonawane, said the insurance company had erred on rejecting the claim of the complainant without any valid reason and hence amounted to deficiency in services. The forum said the insurance company had not come up with proof to counter the claim of the medical certificate mentioning the ‘immediate cause of death’ as head injury. It then ordered the company to settle the claim of Rs 5 lakh along at a 9% rate of interest from December 20, 2017, when the case was rejected.

The forum also ordered Rs 7,000 as compensation for mental harassment of the consumer and Rs 5,000 as compensation for costs incurred.

Source: The Times of India