A consumer forum has observed that unilateral changes made to a mediclaim policy by an insurance firm amount to ‘deficiency in service’.
The forum cited Supreme Court observations: “…old policy is revived and is sort of a substitution of obligations under the old policy unless such policy provides otherwise. It may be that on renewal, a new contract comes into being, but the said contract is on the same terms as of the original policy.” The South Mumbai District Consumer Disputes Redressal Forum directed New India Assurance Co Ltd to reimburse Rs 40,000 and pay Rs 10,000 compensation to a senior citizen, Chandrakant Khare, after the firm fraudulently capped at Rs 24,000, amount due for cataract surgery.
Khare had taken a policy for his wife in 1999 and it was renewed every year. In August 2012, the sum assured to his wife was Rs 1 lakh. In November 2012, she underwent cataract surgery for both eyes and the expense was Rs 88,520.
When he claimed the amount, the company sent two cheques of Rs 24,000 each. Khare told the forum that no terms and condi tions could be changed without his consent and the firm had acted in an unjust manner.
The forum agreed that Khare never got any notice from the firm. “…IRDA has issued directives that senior citizens holding policy for many years shall not be compelled to migrate to revised product on renewal if it is to their disadvantage,” the forum said.
Source : The Times of India
Date : 25/9/2014