Risk firm to cough up Rs 5000 penalty, Rs 87k medical claim

The district consumer forum recently held that United India insurance company had adopted unfair trade practice to avoid repaying medical expenses. It has asked the firm to pay Rs5,000 compensation and Rs87,143 medical expense.

Bomi Gadiwalla’s complaint said his original policy of 2002 had nine clauses but two more were added without informing him. “We noticed it in 2009 when my son, Percy, had a skin disease,” said Gadiwalla.

He said that Percy had to be given injections after which he required medical supervision for at least one day. Gadiwalla’s first claim of Rs83,321 was honoured by the firm. The problem started when  his second claim was rejected as it did not “fit in the newly added clause”. The firm argued that the treatment could have been sought in the OPD.

However, Gadiwalla’s counsel  claimed the firm was being untrue to customers. He also pointed to a Supreme Court judgment that an insurance firm cannot alter clauses.
The forum said there was evidence to suggest that the firm adopted unfair trade practice and ordered it to pay the amount to Gadiwalla.