Good News! Delayed In Filing An Insurance Claim? Your Claim Still Cannot Be Denied!

Featured

Posted on January 15, 2013 by Runjhun

complaint against oriental insurance consumer forum says claims are not timebound

Insurance and good news is an oxymoron in more ways than one. Yet this is one of those rare times when tidings from the insurance industry are favorable for the average consumers.

Predictably, insurance industry is hardly responsible for the good stuff. It flows from the Maharashtra State Consumer Dispute Resolution Commission.

In a landmark verdict that has the potential of fundamentally changing the way the claims are rejected by the insurers in this country, the Maharashtra State Commission has held that insurance claims are not timebound. The ‘deadline’ for filing a claim is not mandatory but only directory and the insurers cannot reject any claim simply because it was filed after the expiry of this ‘deadline’.

This remarkable verdict was delivered by the State Commission while deciding upon a complaint filed by a widow against the Oriental Insurance Company Ltd. The forum directed The Oriental Insurance Company Ltd to pay the widow of a man who died in a 2006 accident the entire claim of Rs 1 lakh plus a compensation of Rs 46,000 even though the claim had been filed well past the one-month ‘deadline’.

The Commission further stated that it has constantly held that giving intimation within specified period or within one month is not a ‘mandatory condition’, but it is a ‘directory’ in nature and breach of this condition does not empower appellant insurance company to forfeit or foreclose the insurance claim required to be duly settled.

And thus, the insurers in the country were duly snatched of one of their favorite grounds for repudiation of valid claims–delay in filing!

Kudos State Commission!

Insurance claims not time-bound: Panel (Times Of India)

Consumer Horror! Diagnostic Center In Delhi Wrongly Diagnoses A Person As HIV+, To Pay 2 Lakhs.

Posted on January 14, 2013 by Runjhun

complaint against diagnostic center for wrongly diagnosing a patient as HIV+, to pay 2L as compensation

Diagnosing someone as HIV+ is bad.

Diagnosing someone as HIV+ wrongly is…you tell me!

One of the worst instances of medical negligence surfaced in New Delhi where a diagnostic laboratory misdiagnosed a person as HIV+.

Horrifying ? You bet.

But this is just the beginning of the story.

As if the horror of the misdiagnosis and trauma of being an HIV+, however briefly was not enough, this particular consumer also lost an employment opportunity abroad because of the diagnosis. The mis-diagnosis had happened when the consumer underwent mandatory fitness tests for a job in Saudi Arabia.

A complaint was filed with the consumer forum and the South West District Consumer Dispute Redressal Forum held that if the test conducted by Paramount Diagnostic Center had to be re-run after four to six weeks to confirm it then the lab could not have reported him unfit on the basis of their (initial) findings… Their haste in declaring him unfit immediately after the test is not only negligent but also rash on their part.

The forum also noted that Paramount`s report had been proved “false” by all subsequent tests including one by the All India Institute of Medical Sciences (AIIMS) which was conducted within two weeks of the “faulty” report. The forum ordered the diagnostic center to pay Rs 2.05 lakh as damages along with Rs.5000 as litigation cost to a 25-year-old youth for wrongly diagnosing him as HIV positive and depriving him of an employment opportunity abroad.

City lab to pay Rs 2.05 lakh for wrongly diagnosing youth as HIV+ (Zee News)

Wedding Woes! Wedding Hall Troubles Or Faulty Banquet Management, Consumer Forum Redresses All!

Posted on January 14, 2013 by Runjhun

complaint against wedding hall owner, banquet management, to pay compensation

Did you know? If you book a wedding hall, you are a consumer!

Marriage season is back and back are the garish decors, blaring music and unarguably, the most shameless magnum opus of wealth, opulence and everything else that the the upper middle class in this country swears by.

Steering clear of the ideological, sociological and psychological debates that are triggered by the Indian marriage extravaganzas, Tadka brings forth two tales that are an uncanny mix of weddings, troubles and consumer forums.

India being India, nothing is sacrosanct and everything, every person and every event is bound to be plagued by troubles–specifically consumer troubles. Weddings are no exceptions and as anyone who have had the (mis)fortune of organizing a wedding in India would vouch, troubles fly faster than the wedding confetti. From troublesome tent owners to unsavory banquet arrangements to problematic wedding hall owners, the range of troubles is as diverse as the wedding rituals.

But fear not. Consumer forums have rose up to the occasion and have undertaken the herculean tasks of actually addressing the wedding troubles.

Case in point is consumer forum verdict from Mumbai.

This was a case where a tax consultant had booked the Imperial banquet hall in Vashi, managed by Kambala Hospitality pvt ltd for hosting the wedding of his daughter Harsha in April 2009. At the time of booking the hall, Kalra had made an advance payment of Rs 50,000 to the proprietor of the banquet hall confirming his booking. Unfortunately, the marriage ceremony had to be cancelled. Kalra promptly informed the banquet management about the cancellation much in advance so that they could lease out their premises to other parties eager on the same date. He sought a refund of his advance.

The proprietor refused the refund but agreed to adjust the amount in any future booking. However, even later, during a fresh booking, the proprietor refused the adjustment. A complaint was filed with the consume forum which held the owner liable and ordered that the aggrieved party be immediately returned the Rs 50,000 advance money besides paying a Rs 10,000 fine and another Rs 2,000 toward legal expenses.

Thane consumer forum fines banquet management (Times of India)

Investor Using A Share Broking Firm? You Are Not A Consumer, Says Consumer Forum.

Posted on January 11, 2013 by Runjhun

investor trading in shares not a consumer says consumer forum

One of the issues that keeps recurring in the complaints filed with Akosha is whether an investor treated as a consumer?

Addressing this question yet again, Thane District Consumer Forum has held that an investor cannot be considered as a consumer because he is indulging in trading in shares for commercial purposes.

This issue was addressed by the forum in response to a complaint filed by an investor using the services of a share broking company, India Infoline Ltd.

As per the complaint, the consumer had opened a Demat account with India Infoline for selling and purchase of share. She deposited Rs 60,555 with the company and Rs 0.05 paise was to be taken as brokerage for trading. It was noticed by the complainant that instead of charging Rs 0.05 paise, they charged Rs 0.10 paise as brokerage. Also, despite a request to stop the transactions from the investor, the company continued the transactions.

However, when the matter was filed with the consumer forum, the forum dismissed the complaint stating that the complainant being an investor trading for commercial purposes was did not fall within the purview of the definition of ‘consumer’ and hence cannot file a complaint with the forum.

Investor trading in shares is not a consumer: Consumer Disputes Redressal Forum (Indian Express)

Number Porting Troubles! Reliance Ports A Number Without Consumer’s Permission, To Pay Compensation.

Posted on December 11, 2012 by Runjhun

Complaint Against Reliance Infocom, To Pay 10K For Porting A Number Without Permission

Picture this–one fine morning your mobile number stops working. And while you scuttle around, trying to figure what is wrong, your calls, the ones being made on YOUR number, are being received…by someone else, with absolutely no connection whatsoever with you or your number.

Not an enviable situation! Is it?

But this is what exactly happens when that monster called number portability is let loose without any semblance of control or care!

A consumer in Delhi learnt this the hard way when his number, which he had been using since 2004 suddenly stopped working in August 2011. He came to know that his number was ported to Airtel without his consent, which in turn was allotted by Airtel to someone else. His request for reallotting the number to him was turned down by Reliance Infocom.

The District Forum held that Reliance Infocom was under an obligation to provide uninterrupted service to complainant and by porting the number without express requisition from his side they are guilty of providing deficient services. The Forum ordered Reliance Infocom to pay Rs 10,000 by way of compensation for deficient services, loss of business, harassment and mental agony meted out to the complainant, including the litigation cost.

Reliance Infocom to pay Rs 10K for unilaterally porting number (Business Standard)

Caught! Delhi State Commission Hauls LIC For Becoming ‘Richest’ By Wrongful Denial Of Mediclaims.

Posted on December 11, 2012 by Runjhun

complaint-against-LIC-to-pay-24-lakhs-for-denial-of-mediclaim

Of course we had known this all this while. And now, consumer forum recognizes it too!

The Life Insurance Corporation of India has become the “richest” organisation in the country by rejecting rightful claims of insured under mediclaim policies on “flimsy” grounds, the Delhi State Consumer Commission has said.

We say, why just LIC? The statement holds true for every insurer in the country. They may not be the ‘richest’ but rich they are and how!

The State Commission too recognized this issue as a major source of concern. In one of the most clear cut stands in the recent times, the Delhi State Commission said, ”We have deprecated this practice of insurance companies of taking a flimsy clue or remote reference from the discharge summary or statement with a view to reject the rightful claim of the insured. It appears that this is how the respondent (LIC) has become one of the richest organisation in India.”

Reiterating another of Tadka’s vehement arguments, the Commission also said that LIC should realise that it “survives and thrives” on consumer and “propensity to become unjustly rich by rejecting their claims” is highly depreciable.

What triggered the Commission’s ire was denial of the claim of a policy holder’s husband, who had died due to infection after surgery for removal of her uterus. The insurance firm had rejected his claim on the sole ground that she had concealed that she had undergone angiography eight years prior to availing the policy despite subjecting her to rigorous medical tests before issuing the policy to her.

Clearly holding that it is the duty of the insurer to ensure that the policy holder is fit before issuing the policy, the Commission also observed that this obligation is not duly discharged by the insurers because they will lose business.

The Commission held that LIC is liable to pay Rs 20 lakh as the amount of the policy to the complainant and it shall also pay Rs four lakh as compensation for mental agony, harassment and sheet suffering to him.

LIC rich by denying claims on flimsy ground: Consumer Forum (Zee News)