No Proof Of Pre-Existing Disease, Kangra District Commission Holds Star Health And Allied Insurance Co Liable For Wrongful Repudiation
9 months ago

No Proof Of Pre-Existing Disease, Kangra District Commission Holds Star Health And Allied Insurance Co Liable For Wrongful Repudiation

Live Law  

The District Consumer Disputes Redressal Commission, Kangra bench of Hemanshu Mishra, Arti Sood and Narayan Thakur held Star Health and Allied Insurance Co. Ltd liable for deficiency in services due to its unjustified rejection of a genuine claim. The bench held that the Insurance Company repudiated the claim without conducting a proper investigation or obtaining affidavits from treating doctors regarding the pre-existing disease. Brief Facts: The Complainant purchased a Family Health Optima Insurance policy from Star Health and Allied Insurance Co., covering his wife and his son for Rs. Feeling aggrieved, the Complainant approached the District Consumer Disputes Redressal Commission, Kangra, Himachal Pradesh and filed a consumer complaint against the Insurance Company.

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History of this topic

Insurance firms draw flak for misinterpreting ‘pre-existing illness’ clause
2 weeks ago

Insurance firms draw flak for misinterpreting ‘pre-existing illness’ clause

New Indian Express  

THIRUVANANTHAPURAM: The State Consumer Disputes Redressal Commission has criticised insurance companies for misinterpreting the clause on “pre-existing illness” to reject legitimate claims. While disposing of a case related to a claim rejection by the Life Insurance Corporation of India, the commission clarified that a pre-existing disease pertains to treatment received within 48 months prior to the issuance of the first …

National Insurance Company Held Liable For Deficiency In Service For Denying Full Policy Amount To Complainant
1 month ago

National Insurance Company Held Liable For Deficiency In Service For Denying Full Policy Amount To Complainant

Live Law  

The District Consumer District Redressal Commission Ernakulam held National Insurance Company Ltd liable for deficiency in service. Claiming the entitlement to receive the rest of the amount, the Complainant approached the Opposite Party stating that the Opposite Party was required to ensure the full payment of the policy amount. Hence, the Complainant approached the District Consumer Disputes Redressal Commission Ernakulam …

Health insurance claims: How to ensure fair grievance redressal
2 months, 1 week ago

Health insurance claims: How to ensure fair grievance redressal

Live Mint  

My health insurance company has rejected my claim because I am unable to furnish internal hospital papers. —Name withheld on request If your insurance claim has been rejected due to lack of documentation, it’s essential to understand your rights under the latest guidelines from the Insurance Regulatory and Development Authority of India. Insurers must assist policyholders in identifying missing documents …

How to ensure fair grievance redressal for health insurance claims? Know here
2 months, 1 week ago

How to ensure fair grievance redressal for health insurance claims? Know here

India TV News  

Being denied a health insurance claim due to lack of documentation can be frustrating, but recent guidelines from the Insurance Regulatory and Development Authority of India aim to address the issue. Simplified documentation Insurers must provide a standardised review of documentation requirements at the time the policy is issued. Written explanation of rejections If the claim is denied, insurers must …

Insurers Cannot Introduce New Repudiation Grounds : Delhi State Commission Holds National Insurance Liable
2 months, 2 weeks ago

Insurers Cannot Introduce New Repudiation Grounds : Delhi State Commission Holds National Insurance Liable

Live Law  

The Delhi State Commission, presided by Justice Sangita Dhingra Sehgal and Ms. Pinki held National Insurance liable for deficiency in service over wrongful repudiation of legitimate insurance claims. Aggrieved, the insurer appealed before the State Commission of Delhi Contentions of the Insurer The insurer contended that the complainant violated policy conditions by failing to disclose a past fire incident. Observations …

Baramulla Consumer District Commission Holds Insurance Company Liable For Non-Settlement Of Genuine Claim Amounts
2 months, 3 weeks ago

Baramulla Consumer District Commission Holds Insurance Company Liable For Non-Settlement Of Genuine Claim Amounts

Live Law  

The Baramulla District Consumer Disputes Redressal Commission has held Reliance General Insurance company liable for repudiating the genuine insurance claim of the complainant in an unreasonable manner. Brief background: The complainant purchased a vehicle truck TATA Signa from Fear Deal TATA motors in Srinagar and got it insured with Reliance General Insurance company for an amount of Rs. The Insurance …

Consumer Cases Annual Digest 2024 [Part -I]
2 months, 2 weeks ago

Consumer Cases Annual Digest 2024 [Part -I]

Live Law  

Supreme Court Medical Negligence | Supreme Court Awards Rs 10 Lakh Compensation To Patient Who Developed Hoarseness In Voice After Trainee Gave Anaesthesia Case Title: J. DOUGLAS LUIZ THROUGH LEGAL REPRESENTATIVES VERSUS MANIPAL HOSPITAL | CIVIL APPEAL NO.1700 OF 2024 Citation: 2024 LiveLaw 134 The Supreme Court recently awarded Rs. National Consumer Disputes Redressal Commission Rejection Of A Surveyor's Report …

NCDRC Holds Bajaj Insurance Liable For Deficiency In Service Over Wrongful Repudiation Of Insurance Claim
2 months, 3 weeks ago

NCDRC Holds Bajaj Insurance Liable For Deficiency In Service Over Wrongful Repudiation Of Insurance Claim

Live Law  

The National Consumer Disputes Redressal Commission, presided by AVM J. Rajendra held Bajaj Allianz Life Insurance liable for deficiency in service over wrongful repudiation of a legitimate insurance claim and overturned the State Commission's order. Brief Facts of the Case The complainant's son had purchased a life insurance policy from Bajaj Allianz Life Insurance/insurer with an annual premium and a …

Delhi State Commission Holds National Insurance Company Liable For Rejecting Claim Due To Bariatric Surgery
2 months, 3 weeks ago

Delhi State Commission Holds National Insurance Company Liable For Rejecting Claim Due To Bariatric Surgery

Live Law  

The State Consumer Disputes Redressal Commission, Delhi presided by Ms. Bimla Kumari held National Insurance Co. Ltd liable for rejecting the insurance claim of complainant as she underwent Bariatric Surgery due to morbid obesity. Through an order dated 17.03.2020, the District Commission held that the insurance company was liable as the complainant underwent treatment due to serious health issues and …

Uttarakhand State Commission Holds National Insurance Liable For Deficiency In Service Over Denial Of Legitimate Claim Amount
3 months ago

Uttarakhand State Commission Holds National Insurance Liable For Deficiency In Service Over Denial Of Legitimate Claim Amount

Live Law  

The Uttarakhand State Commission, presided by Mr. M.K. Singh held National Insurance liable for deficiency in service and upheld the District Commission's order. Consequently, the insurer appealed before the State Commission of Uttarakhand. Contentions of the Insurer The insurer argued that the complainant breached policy terms and did not intimate the theft promptly. However, the complainant contended that the insurer …

Insurance Claims Cannot Be Denied For Pre-Existing Ailments Without Prior Medical Tests: Delhi State Commission
3 months ago

Insurance Claims Cannot Be Denied For Pre-Existing Ailments Without Prior Medical Tests: Delhi State Commission

Live Law  

The Delhi State Commission has held that denial of insurance claim on the ground of pre-existing ailments is unjustified where no medical tests were conducted before issuing the policy. Observations: The bench relied on the judgment in Pradeep Kumar Garg vs National Insurance Co. ltd. FA 482/2005 and observed that until a person is hospitalised for a disease closer to …

Doctors Cannot Be Held Liable Without Reliable Evidence Of Medical Negligence: Delhi District Commission
3 months, 1 week ago

Doctors Cannot Be Held Liable Without Reliable Evidence Of Medical Negligence: Delhi District Commission

Live Law  

The Delhi District Consumer Dispute Redressal Commission has dismissed a case of medical negligence against Employee State Insurance hospital and its surgeons for an unsuccessful tubectomy operation. It was observed by the Apex Court that no case of medical negligence can be sustained merely because of failure of sterilization unless supported by some cogent expert evidence. The bench also relied …

Chandigarh State Commission Holds New India Assurance Company Liable For Rejecting Insurance Policy Due To Unreliable Evidence
3 months, 1 week ago

Chandigarh State Commission Holds New India Assurance Company Liable For Rejecting Insurance Policy Due To Unreliable Evidence

Live Law  

The State Consumer Disputes Redressal Commission, Chandigarh presided by Justice Raj Shekhar Attri and Mr. Rajesh K. Arya held 'New India Assurance Company Limited' liable for rejecting the insurance policy of the complainant on the basis of unreliable evidence about alcohol consumption by the complainant. Brief facts: The complainant insured his Honda Jazz car for ₹4,80,000/- with New India Assurance …

Idukki District Commission Holds Star Health And Allied Insurance Company Liable For Rejection Of Insurance Claims
3 months, 1 week ago

Idukki District Commission Holds Star Health And Allied Insurance Company Liable For Rejection Of Insurance Claims

Live Law  

The District Consumer Disputes Redressal Commission, Idukki presided by Sri. held Star Heath and Allied Insurance Company liable for grave deficiency in service as they denied the claim of the complainant due to insufficient document. Brief facts: The complainant purchased medical insurance for his family from Star Health and Allied Insurance Company which was valid from 12.8.2021 to 11.8.2022. Contentions …

Uttarakhand State Commission Holds United India Insurance Company Liable For Rejecting Insurance Claim Suffered Due To Heavy Rains
3 months, 1 week ago

Uttarakhand State Commission Holds United India Insurance Company Liable For Rejecting Insurance Claim Suffered Due To Heavy Rains

Live Law  

The State Consumer Disputes Redressal Commission, Uttarakhand presided by Ms. Kumkum Rani and Mr. B.S. Manral, held United India Insurance Company liable for rejecting the insurance claim of the complainant as loss suffered due to heavy rain was covered under the terms of their insurance policy. The commission relied on importance of surveyor's report and modified the compensation amount accordingly, …

Telangana State Commission Holds LIC Liable For Deficiency In Service Over Wrongful Repudiation Of Insurance Claim
3 months, 1 week ago

Telangana State Commission Holds LIC Liable For Deficiency In Service Over Wrongful Repudiation Of Insurance Claim

Live Law  

The Telangana State Commission, presided by Smt. V. V. Seshubabu held Life Insurance Corporation liable for deficiency in service for wrongful repudiation of a legitimate insurance claim. However, the insurer rejected the insurance claim of the complainant on grounds that there was no permanent disability. Observations by the State Commission The Commission observed that the insurer rejected the claim, stating …

Additional Claims Cannot Be Made Once The Claim Is Accepted Unconditionally: Uttarakhand State Commission Allows Insurance Company's Appeal
3 months, 1 week ago

Additional Claims Cannot Be Made Once The Claim Is Accepted Unconditionally: Uttarakhand State Commission Allows Insurance Company's Appeal

Live Law  

The Uttarakhand State Consumer Disputes Redressal Commission bench of Ms. Kumkum Rani and Mr. B.S. Being aggrieved, the Complainant filed a complaint before the District Consumer Disputes Redressal Commission, Haridwar against the insurance company. Contentions of Reliance General Insurance Co. Ltd: The Appellant contended complainant was engaged in commercial activity and was not entitled to any compensation from the insurance …

Delhi State Commission Holds IFFCO-Tokio Liable For Deficiency In Service Over Wrongful Repudiation Of Claim
3 months, 2 weeks ago

Delhi State Commission Holds IFFCO-Tokio Liable For Deficiency In Service Over Wrongful Repudiation Of Claim

Live Law  

The Delhi State Commission, presided by Justice Sangita Dhingra Sehgal and Ms. Pinki held IFFCO-Tokio General Insurance liable for deficiency in service over wrongful repudiation of a legitimate insurance claim. Contentions of the Insurer The insurer argued that the complainant is not a “consumer” under the Consumer Protection Act, 1986, as the insurance was bought for commercial purposes. Observations by …

Delayed Intimation To Insurer Does Not Warrant Total Rejection Of Claims: Delhi State Commission Holds New India Assurance Liable For Deficiency In Service
3 months, 2 weeks ago

Delayed Intimation To Insurer Does Not Warrant Total Rejection Of Claims: Delhi State Commission Holds New India Assurance Liable For Deficiency In Service

Live Law  

The Delhi State Commission, presided by Justice Sangita Dhingra Sehgal, Ms. Pinki held that an insurer cannot reject a claim solely on the basis of late intimation by the insured as such an act amounts to deficiency in service. Brief Facts of the Case The complainant, a poor villager, purchased a tractor for agricultural work, financed by the State Bank …

Rejection Of Insurance Claim Valid If Insured Does Not Follow Policy Terms: Delhi State Commission Reject Claims Of Deficiency Against National Insurance
3 months, 2 weeks ago

Rejection Of Insurance Claim Valid If Insured Does Not Follow Policy Terms: Delhi State Commission Reject Claims Of Deficiency Against National Insurance

Live Law  

The Delhi State Commission, presided by Justice Sangita Dhingra Sehgal And Ms. Pinki held that the insurer can reject the insurance claim if the insured has not complied with the policy terms stated. Her son later approached the insurer to request a name change on the policy but was told to first update the vehicle's ownership with the RTO. According …

Denial Of Insurance Claim Is Justified In Case Of Breach Of Insurance Contract By The Insured Person: Delhi State Commission
3 months, 2 weeks ago

Denial Of Insurance Claim Is Justified In Case Of Breach Of Insurance Contract By The Insured Person: Delhi State Commission

Live Law  

Delhi State Consumer Disputes Redressal Commission ruled that denial of insurance claim by “United India Assurance Co. ltd.” is valid where the insured person violates the terms of insurance policy. A coram of President Sangita Dhingra Sehgal and Judicial member Pinki held that non-submission of requisite and essential documents,as per the terms of policy, by the Complainant for due assessment …

Rejection Of Claim Within Policy Waiting Period Not Deficiency In Service: Uttarakhand State Commission Allows Appeal By Universal Sompo General Insurance
3 months, 2 weeks ago

Rejection Of Claim Within Policy Waiting Period Not Deficiency In Service: Uttarakhand State Commission Allows Appeal By Universal Sompo General Insurance

Live Law  

The Uttarakhand State Commission, presided by Ms. Kumkum Rani and Mr. B.S. Manral held that an insurer's rejection of the claim due to the applicable waiting period under the policy does not constitute a deficiency in service. Observations by the State Commission The State Commission noted that the insurer had disallowed the claim on the grounds of the one year …

Anantapur District Commission Holds Shriram General Insurance Co. Liable For Wrongful Repudiation Of Valid Claim
3 months, 2 weeks ago

Anantapur District Commission Holds Shriram General Insurance Co. Liable For Wrongful Repudiation Of Valid Claim

Live Law  

The District Consumer Disputes Redressal Commission, Anantapur bench of Smt. D. Grace Mary and Sir B. Gopinath held 'Shriram General Insurance Company Limited' liable for deficiency in service for its failure to settle a valid claim amount assessed under IRDA approved survey findings. Observations of the Commission: The District Commission observed that the Insurance Company had appointed an IRDA-approved surveyor …

Injury Must Be Direct Cause Of Death To Claim Insurance Under Accidental Death: Telangana State Commission Dismisses Appeal Against United India Insurance
3 months, 2 weeks ago

Injury Must Be Direct Cause Of Death To Claim Insurance Under Accidental Death: Telangana State Commission Dismisses Appeal Against United India Insurance

Live Law  

The Telangana State Commission, presided by Smt. V. V. Seshubabu held that to claim the insurance policy under accidental death, the insured's death should directly have been caused by the injury in question. Observations by the State Commission The State Commission highlighted that the complainant's husband, while being taken to the operation theatre for a spinal fusion surgery, suffered a …

Kerala State Commission Upholds Order Against Reliance Insurance Company To Pay Treatment Expenses To Complainant
3 months, 2 weeks ago

Kerala State Commission Upholds Order Against Reliance Insurance Company To Pay Treatment Expenses To Complainant

Live Law  

While upholding the decision of the Kasaragod District Consumer Disputes Redressal Commission, the Kerala State Consumer Disputes Redressal Commission bench comprising of Mr. Justice B. Sudheendra Kumar, Mr. Ajith Kumar and Mr. Radhakrishnan K.R. Previously, District Commission had held Reliance Insurance liable for the deficiency of service for not paying the claim of the complainant who had taken coverage of …

[Motor Accident] Adverse Inference Can Be Drawn Against Insurer On Failure To Rebut Evidence: Jharkhand HC Upholds ₹11.45 Lakh Compensation
4 months ago

[Motor Accident] Adverse Inference Can Be Drawn Against Insurer On Failure To Rebut Evidence: Jharkhand HC Upholds ₹11.45 Lakh Compensation

Live Law  

The Jharkhand High Court has upheld the award of ₹11,45,932 granted by the Motor Accident Claims Tribunal, Dhanbad, to the widow of a carpenter who succumbed to injuries sustained in a fatal motorcycle accident. The court emphasised that failure of the insurance company to summon key witnesses or rebut the evidence presented by the claimants resulted in an adverse inference …

Bihar State Commission Holds Bajaj Allianz General Insurance Co. Liable For Wrongful Repudiation of Valid Claim
4 months, 1 week ago

Bihar State Commission Holds Bajaj Allianz General Insurance Co. Liable For Wrongful Repudiation of Valid Claim

Live Law  

The State Consumer Disputes Redressal Commission, Bihar bench of Gita Verma and Md. Shamim Akhtar held Bajaj Allianz General Insurance Co. Ltd. liable for deficiency in service for wrongfully repudiating a valid insurance claim despite receiving all required documents. The van was also insured with Bajaj Allianz General Insurance Co. Ltd., with a coverage of Rs. Based on the unchallenged …

National Commission Rejects Oriental Insurance's Appeal, Finds Them Liable for Deficiency in Service
4 months, 2 weeks ago

National Commission Rejects Oriental Insurance's Appeal, Finds Them Liable for Deficiency in Service

Live Law  

National Consumer Disputes Redressal Commission (NCDRC) has held Oriental Insurance liable for deficiency in service in a case concerning a medical insurance claim. The insurer argued that the treatment received by the complainant's wife was for weight reduction, which was excluded under the insurance policy's exclusion clause. However, the National Commission found that the insurer failed to prove that the …

Terms Of Insurance Contracts Should Be Strictly Interpreted: NCDRC
5 months, 2 weeks ago

Terms Of Insurance Contracts Should Be Strictly Interpreted: NCDRC

Live Law  

The National Consumer Disputes Redressal Commission, presided by Mr. Subhash Chandra and Dr. Sadhna Shanker, dismissed an appeal against National Insurance Company and held that insurance contract terms must be strictly interpreted, with precise adherence to their explicit wording and no alterations made. Contentions of the Insurer The insurer contended that the complainants secured a home loan to purchase the …

Himachal Pradesh State Commission Holds United India Insurance Co. Liable For Wrongful Repudiation Of Valid Claim
5 months, 3 weeks ago

Himachal Pradesh State Commission Holds United India Insurance Co. Liable For Wrongful Repudiation Of Valid Claim

Live Law  

The State Consumer Disputes Redressal Commission, Himachal Pradesh bench of Justice Inder Singh Mehta held 'United India Insurance Company Limited' liable for wrongful repudiation of a medical claim based on erroneous interpretation of the policy's clauses. Observations of the State Commission: The State Commission observed the condition stated by the Insurance Company for repudiating the claim, was not applicable to …

Delay In Informing Insurer Of Theft Shouldn't Automatically Repudiate Insurance Claim: NCDRC
7 months, 1 week ago

Delay In Informing Insurer Of Theft Shouldn't Automatically Repudiate Insurance Claim: NCDRC

Live Law  

The National Consumer Disputes Redressal Commission, presided by AVM J. Rajendra, held National Insurance liable for deficiency in service and held that the interpretation of insurance policy terms should consider the context and the parties' intentions and mere delay in informing the insurer of theft does not automatically repudiate the insurance claim. Observations by the National Commission The National Commission …

Insurance Contracts Imply Duty Of Disclosure By Insured: NCDRC
7 months, 1 week ago

Insurance Contracts Imply Duty Of Disclosure By Insured: NCDRC

Live Law  

The National Consumer Disputes Redressal Commission, presided by AVM J. Rajendra, held that insurance contracts imply a duty of disclosure, and the contracts are voidable at the option of the insurer in case of concealment of information. Brief Facts of the Case The complainant's wife took out a policy under 'Jeevan Anand' from Life Insurance Corporation/insurer, with a sum assured …

East Godavari District Commission Holds Aditya Birla Health Insurance Co. Liable For Wrongful Repudiation Of Valid Claim
7 months, 2 weeks ago

East Godavari District Commission Holds Aditya Birla Health Insurance Co. Liable For Wrongful Repudiation Of Valid Claim

Live Law  

The District Consumer Disputes Redressal Commission, East Godavari bench of Sri D. Kodanda Rama Murthy, Sri S. Suresh Kumar and Smt. Lakshmi held Aditya Birla Health Insurance Company Ltd. liable for wrongful repudiation of a valid health insurance claim based on pre-existing diseases. Brief Facts: The Complainant obtained a health insurance policy from Aditya Birla Health Insurance Co. Ltd. for …

Insurance Contracts Based On 'Utmost Good Faith', Suppression Of Material Facts May Lead To Repudiation: Madhya Pradesh State Commission
7 months, 3 weeks ago

Insurance Contracts Based On 'Utmost Good Faith', Suppression Of Material Facts May Lead To Repudiation: Madhya Pradesh State Commission

Live Law  

The State Consumer Disputes Redressal Commission, Madhya Pradesh bench of Shri A.K. Brief Facts: The Complainant's deceased wife had obtained an insurance policy from Life Insurance Corporation of India, for a sum insured of Rs. However, LIC repudiated the claim, stating that the deceased wife had not disclosed correct facts regarding her previous medical history and had suppressed material facts …

Consumer Cases Weekly Round-Up: 22nd To 28th July 2024
7 months, 2 weeks ago

Consumer Cases Weekly Round-Up: 22nd To 28th July 2024

Live Law  

State Consumer Disputes Redressal Commission, Goa Insurer Not Liable For Unreasonable Delay In Claim Intimation, Goa State Commission Dismisses Appeal Against Oriental Insurance Company The State Consumer Disputes Redressal Commission, Goa bench comprising Mrs Varsha R. Bale and Ms Rachna Anna Maria Gonsalves dismissed an appeal against Oriental Insurance Company, based on an unreasonable delay on the Complainant's part while …

Ernakulam District Commission Holds Future Generali India Insurance Co. Liable For Wrongful Repudiation Of Genuine Medical Claim
7 months, 3 weeks ago

Ernakulam District Commission Holds Future Generali India Insurance Co. Liable For Wrongful Repudiation Of Genuine Medical Claim

Live Law  

The District Consumer Disputes Redressal Commission, Ernakulam bench of Shri D.B. held Future Generali India Insurance Company Ltd. liable for deficiency in service. Brief Facts: The Complainant took a Corona Rakshak Policy from Future Generali India Insurance Company Limited. Therefore, the District Commission held that the Insurance Company wrongfully repudiated the Complainant's claim. Case Title: Ajaychand V. vs Future Generali …

Deciding Time-Barred Consumer Complaints Is Illegal, Uttarakhand State Commission Sets Aside Order Against Shriram General Insurance Co.
8 months ago

Deciding Time-Barred Consumer Complaints Is Illegal, Uttarakhand State Commission Sets Aside Order Against Shriram General Insurance Co.

Live Law  

The State Consumer Disputes Redressal Commission, Uttarakhand bench of Ms Kumkum Rani and Mr B.S. Feeling aggrieved, the Complainant filed a consumer complaint before the District Consumer Disputes Redressal Commission, Haridwar, Uttarakhand. Aggrieved by this decision, the Insurance Company filed an appeal before the State Consumer Disputes Redressal Commission, Uttarakhand. Observations of the Commission: The State Commission observed that the …

Consumer Cases Half-Yearly Digest: January To June 2024
8 months ago

Consumer Cases Half-Yearly Digest: January To June 2024

Live Law  

Supreme Court Medical Negligence | Supreme Court Awards Rs 10 Lakh Compensation To Patient Who Developed Hoarseness In Voice After Trainee Gave Anaesthesia Case Title: J. DOUGLAS LUIZ THROUGH LEGAL REPRESENTATIVES VERSUS MANIPAL HOSPITAL | CIVIL APPEAL NO.1700 OF 2024 Citation: 2024 LiveLaw 134 The Supreme Court recently awarded Rs. National Consumer Disputes Redressal Commission Rejection Of A Surveyor's Report …

Consumer Complaints Must Be Lodged Within Two Years From Date Of Cause Of Action: Delhi State Commission
8 months, 1 week ago

Consumer Complaints Must Be Lodged Within Two Years From Date Of Cause Of Action: Delhi State Commission

Live Law  

The Delhi State Commission, presided by Justice Sangita Dhingra Sehgal and Ms. Pinki, dismissed a complaint against Oriental Insurance Ltd., citing the presence of a limitation clause. It was further held that consumer complaints are time-barred and need to be filed within two years from the date of the action unless sufficient reasons are present. Observations by the State Commission …

Courts Must Favour Complainant In Case Of Presence Of Two Interpretations Of Same Clause: Ernakulam District Commission
8 months, 3 weeks ago

Courts Must Favour Complainant In Case Of Presence Of Two Interpretations Of Same Clause: Ernakulam District Commission

Live Law  

The Ernakulam District Commission, presided by Shri. Sreevidhia T.N., held Star Health & Allied Insurance liable for deficiency in service and unfair trade practice. The insurer maintained there was no deficiency in service or unfair trade practice, contested the ₹1,20,000 hospitalization expenses, and argued any liability should be limited to ₹95,286, excluding non-medical expenses. Observations by the District Commission The …

Surveyor's Report Can't Be Rejected Unless Arbitrary: NCDRC
8 months, 3 weeks ago

Surveyor's Report Can't Be Rejected Unless Arbitrary: NCDRC

Live Law  

The National Consumer Disputes Redressal Commission, presided by Justice Ram Surat Maurya, allowed an appeal by United India Insurance and held that the surveyor's report in an insurance cannot be rejected unless proved to be arbitrary and unreasonable. Brief Facts of the Case The complainant, a poultry feed producer, stored raw and finished materials in a building insured by United …

Mere Deduction Of Premium Does Not Create Binding Insurance Contract, Uttarakhand State Commission Dismisses Appeal Against New India Assurance Co.
9 months, 1 week ago

Mere Deduction Of Premium Does Not Create Binding Insurance Contract, Uttarakhand State Commission Dismisses Appeal Against New India Assurance Co.

Live Law  

The State Consumer Disputes Redressal Commission, Uttarakhand bench of Kumkum Rani and Mr B.S. The bench dismissed an appeal filed against the New India Assurance Co. by holding that there existed no renewed insurance contract at the time of the loss and the Insurance Company refunded the premium which was automatically deducted by the bank. Feeling aggrieved, the Complainant filed …

Rejection Of The Health Insurance Claim Cannot Be Based Solely On Assumption Of Pre-Existing Condition: Delhi State Commission
10 months, 2 weeks ago

Rejection Of The Health Insurance Claim Cannot Be Based Solely On Assumption Of Pre-Existing Condition: Delhi State Commission

Live Law  

Delhi State Consumer Disputes Redressal Commission, headed by Justice Sangita Dhingra Sehgal alongside members Ms. Pinaki and Mr. J.P. Agrawal, held HDFC Insurance liable for deficiency in service over the rejection of a health insurance claim solely on the presence of non-communication of pre-existing conditions. Brief Facts of the Case The complainant's husband applied for an HDFC Life Group Credit …

Exclusion Of Coverage For Injuries Sustained During Initial Days Of Policy Issuance Is Illegal, Uttarakhand State Commission Holds Birla Sun Life Insurance Co. Liable
10 months, 3 weeks ago

Exclusion Of Coverage For Injuries Sustained During Initial Days Of Policy Issuance Is Illegal, Uttarakhand State Commission Holds Birla Sun Life Insurance Co. Liable

Live Law  

The State Consumer Disputes Redressal Commission, Uttarakhand bench comprising Ms Kumkum Rani and Mr B.S. Manral held Birla Sun Life Insurance Company liable for repudiating a valid claim based on an unreasonable policy clause excluding coverage for injuries sustained within 90 days from the issuance of the policy. Brief Facts: The Complainant purchased an insurance policy from Birla Sun Life …

Panipat District Commission Holds Muthoot Finance And Liberty General Insurance Co. Liable For Wrongful Repudiation Of Medical Claim
10 months, 3 weeks ago

Panipat District Commission Holds Muthoot Finance And Liberty General Insurance Co. Liable For Wrongful Repudiation Of Medical Claim

Live Law  

The District Consumer Disputes Redressal Commission, Panipat bench comprising Dr R.K. Dogra and Dr Rekha Chaudhary held Muthoot Finance Limited and Liberty General Insurance Company liable for deficiency in service for failure to reimburse the insurance claim even after receiving the requisite documents. Feeling aggrieved, the Complainant approached the District Consumer Disputes Redressal Commission, Panipat, Haryana and filed a consumer …

Ernakulam District Commission Holds Oriental Insurance Liable For Deficiency In Service Due To Non-Disclosure Of Policy Terms During The Signing Of The Contract
11 months, 2 weeks ago

Ernakulam District Commission Holds Oriental Insurance Liable For Deficiency In Service Due To Non-Disclosure Of Policy Terms During The Signing Of The Contract

Live Law  

The Ernakulam District Consumer Disputes Redressal Commission, headed by D.B. Upon visiting the insurer's office and providing details of pre-existing conditions, the complainant requested to port their existing policy, which the insurer agreed to do. Observations by the Commission The Commission observed that the insurer had failed to provide the complainant with the necessary terms and conditions of the policy …

Surveyor's Report Can't Be Disregarded Without Valid Reasons, Delhi State Commission Dismisses Appeal Against National Insurance Co. Ltd.
1 year ago

Surveyor's Report Can't Be Disregarded Without Valid Reasons, Delhi State Commission Dismisses Appeal Against National Insurance Co. Ltd.

Live Law  

The State Consumer Disputes Redressal Commission, Delhi bench comprising Justice Sangita Dhingra Sehgal and Pinki dismissed an appeal against the National Insurance Company Ltd. The State Commission concluded that the Insurance Company rightly repudiated the insurance claim covering burglary risk by acting upon the surveyor's report as it is. After examining these documents, the District Commission agreed with the Insurance …

Kerala consumer commission slams insurer, TPA for rejecting claim of elderly couple
1 year ago

Kerala consumer commission slams insurer, TPA for rejecting claim of elderly couple

New Indian Express  

THIRUVANANTHAPURAM: The State Consumer Disputes Redressal Commission has rapped Bajaj Allianz General Insurance Co. Ltd. and its Third Party Agent for rejecting the claims by an elderly couple. The commission severely criticised the TPA for going beyond its intended role and directly rejecting the claims. The Ernakulam District CDRC had earlier rejected the couple’s petition approving the respondents’ claim that …

U.P. State Commission Holds LIC Liable For Wrongful Repudiating Of Claim Based On Deceased's Smoking Habits
1 year ago

U.P. State Commission Holds LIC Liable For Wrongful Repudiating Of Claim Based On Deceased's Smoking Habits

Live Law  

The State Consumer Disputes Redressal Commission, Uttar Pradesh held LIC liable for wrongfully repudiating a valid claim based on the reason that the deceased failed to disclose the fact that he used to smoke cigarettes and bidis, at the inception of the policy. Feeling aggrieved, the Complainant filed a consumer complaint in the District Consumer Disputes Redressal Commission, Gonda, Uttar …

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