New India Assurance Co Ltd changed policy ‘sans notice’, to pay Rs 2 lakh

Observing that an insurance company cannot make changes to a policy during its renewal without informing the insured, a district forum has ordered New India Assurance Co Ltd and Raksha TPA to reimburse a Worli resident Rs 1.1lakh that he spent on a hernia surgery in 2010, along with a compensation of around Rs 83,000.

The insurance company had agreed to reimburse only Rs 31,000 while rejecting the rest of the claim on the grounds that the man had paid that amount in cash to the doctor, which was against its conditions. The forum however observed that the insured had no idea that changes had been made to the conditions of the policy, and that mode of payment could not be cash. “Due to lack of proper communication in writing from the opposite parties to the complainant, itself is a deficiency in service,” the consumer forum said.

The forum said that the insurance company and third party administrator deducted Rs 82,000 illegally and arbitrarily.

The insured, Kapil Malhotra, had submitted his plea before the South Mumbai District Consumer Disputes Redressal Forum on January 20, 2012. He said that he had first obtained the mediclaim policy in 2007, and after paying an annual premium of Rs 7,726, he was assured a sum of Rs 5 lakh. Malhotra told the forum that he underwent the surgery in 2009. The insurance company only approved part of the claim and sent him a cheque for Rs 31,000 which he returned.

Source: The Times of India