Insurance company to pay Rs 10 lakh for 'wrongfully denying' claim

INDORE: Consumer forum has ordered a private insurance company to pay Rs 10 lakh claim money to complainant along with an interest of 9% from October 7, 2015.

The forum also ordered company to pay Rs 10,000 for mental harassment and Rs2,000 for expenses incurred in litigation. The bench comprising chairman Omprakash Sharma and Sumitra Hathiwala passed the order while deciding complaint of Rajesh Nair filed through advocate KK Chaturvedi.

Chaturvedi told forum that Nair had taken an individual accident insurance policy for his family from Apollo Munich Health Insurance Company Limited for a period of January 28, 2015 to January 27, 2016. According to policy, accident leading to death was covered for Rs 2crore, permanent disability for Rs 15 lakh and hospital expensed for Rs 1 lakh, Chaturvedi said.

The complainant's little finger was cut from his hand after it got stuck behind door of bathroom. According to policy, the company was to pay five per cent of total insured sum of Rs2 crore if little finger was damaged, said Chaturvedi. Complainant informed insurance company representative, provided him certificate from doctor of Apollo hospital, pictures and relevant document in September 2015, said Chaturvedi.

But, the respondent rejected his claim stating that full work capacity was not lost and mere cutting of little finger of right hand couldn't be considered as permanent disability, said Chaturvedi. Complainant had also made a cap for the removed finger, which cost him Rs 19,400. He informed the insurance company about it but it paid nothing, said Chaturvedi.

Respondent counsel said that complainant didn't figure into category of consumer. Also, complainant should have filed a civil suit in this case. However, the forum rejected the claim of respondent counsel and ordered company to pay insurance money.

Source: The Times of India