National Commission Rejects Oriental Insurance's Appeal, Finds Them Liable for Deficiency in Service
5 months 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 surgery was solely for obesity-related treatment, as established in previous legal precedents. The NCDRC dismissed the insurer's revision petition, finding that the burden of proof regarding the applicability of exclusion clauses lies with the insurer.

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History of this topic

Delhi State Commission Holds Oriental Insurance Co. Liable For Wrongful Repudiation Of Valid Medical Claims
5 days, 7 hours ago

Delhi State Commission Holds Oriental Insurance Co. Liable For Wrongful Repudiation Of Valid Medical Claims

Live Law  

The State Consumer Disputes Redressal Commission, Delhi bench of Justice Sangita Dhingra Sehgal and Mr J.P. Agrawal dismissed an appeal filed by 'Oriental Insurance Company' and held it liable for wrongful repudiation of valid medical claims based on an invalid exclusion clause. The District Commission held that the Insurance Company failed to properly supply the terms and conditions of the …

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

Delay In Settling Insurance Claim: NCDRC Holds Oriental Insurance Liable For Deficiency In Service
2 months, 3 weeks ago

Delay In Settling Insurance Claim: NCDRC Holds Oriental Insurance Liable For Deficiency In Service

Live Law  

The National Consumer Disputes Redressal Commission, presided by Mr. Subhash Chandra and Dr. Sadhna Shanker held Oriental Insurance liable for deficiency in service over wrongful repudiation and delay in settling the insurance claim amount. Brief Facts of the Case The complainant insured their ferro alloy production unit with Oriental Insurance under a Standard Fire and Special Perils Policy, covering material …

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

Uttarakhand State Commission Holds National Insurance Liable For Deficiency In Service Over Denial Of Legitimate Claim Amount
3 months, 1 week 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, 1 week 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 …

Violations Must Constitute Fundamental Breach To Deny Insurance Claim: NCDRC Holds Bharti General Insurance Liable For Deficiency In Service
3 months, 2 weeks ago

Violations Must Constitute Fundamental Breach To Deny Insurance Claim: NCDRC Holds Bharti General Insurance Liable For Deficiency In Service

Live Law  

The National Consumer Disputes Redressal Commission, presided by AVM J. Rajendra held that for an insurer to deny a legitimate claim, the violations alleged by them have to constitute a fundamental breach. Observations by the National Commission The National Commission observed that the central issue in this case was whether leaving the key in the vehicle was a fundamental breach …

Telangana State Commission Holds LIC Liable For Deficiency In Service Over Wrongful Repudiation Of Insurance Claim
3 months, 2 weeks 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 …

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, 3 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 …

Bariatric Surgery Addressing Chronic Disease Is Life-Saving Procedure : Delhi State Commission Holds United India Insurance For Deficiency In Service
3 months, 3 weeks ago

Bariatric Surgery Addressing Chronic Disease Is Life-Saving Procedure : Delhi State Commission Holds United India Insurance For Deficiency In Service

Live Law  

The Delhi State Commission, presided by Justice Sangita Dhingra Sehgal, Ms. Pinki held that Bariatric surgeries for chronic diseases is a life saving procedure and cannot be excluded from standard policy terms. The case concerned a health insurance policy covering the complainant and family, under which the insurer denied a claim citing clause 4.9 of the policy terms. However, case …

NCDRC Holds Insurance Company Liable for Wrongful Repudiation of Fire Claim Submitted by NALCO
4 months, 4 weeks ago

NCDRC Holds Insurance Company Liable for Wrongful Repudiation of Fire Claim Submitted by NALCO

Live Law  

National Consumer Disputes Redressal Commission (NCDRC) has held Oriental Insurance Co. liable for wrongfully repudiating a fire claim submitted by National Aluminium Company Ltd. (NALCO). The Insurance Company cited an exclusion clause for repudiating the claim based on unsubstantiated ambiguities w.r.t. the source of the fire. However, the NCDRC found that the exclusion clause was not applicable since the damage …

Terms Of Insurance Contracts Should Be Strictly Interpreted: NCDRC
5 months, 4 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 …

Delay In Informing Insurer Of Theft Shouldn't Automatically Repudiate Insurance Claim: NCDRC
7 months, 2 weeks 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 …

Consumer Cases Half-Yearly Digest: January To June 2024
8 months, 1 week 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 …

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

No Proof Of Pre-Existing Disease, Kangra District Commission Holds Star Health And Allied Insurance Co Liable For Wrongful Repudiation
9 months, 1 week 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 …

Quantification In Insurance Is Mandatory Even For Inadmissible Claims: NCDRC
9 months, 3 weeks ago

Quantification In Insurance Is Mandatory Even For Inadmissible Claims: NCDRC

Live Law  

The National Consumer Disputes Redressal Commission, presided by Mr. Subhash Chandra and Dr. Sadhna Shanker, held that in the insurance industry, quantifying a loss is a standard procedural step that surveyors must perform for every claim, regardless of whether that claim is ultimately deemed admissible or not. However, upon receipt of the claim, the insurer repudiated it, contending that the …

Consumer Cases Weekly Round Up: 30th December 2024 – 5th January 2025
10 months, 3 weeks ago

Consumer Cases Weekly Round Up: 30th December 2024 – 5th January 2025

Live Law  

National Consumer Disputes Redressal Commission NCDRC Holds Experion Developers Liable For Deficiency In Service Case Title: Mitesh Bhalla & Anr. 1196/2018 The National Consumer Disputes Redressal Commission, presided by Mr. Subhash Chandra and Dr. Sadhna Shanker held Oriental Insurance liable for deficiency in service over wrongful repudiation and delay in settling the insurance claim amount. Delhi Consumer Disputes Redressal Commission …

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

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, 4 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 …

Failure To Reimburse Full Amount, Kurukshetra District Commission Holds Bajaj Allianz General Insurance Co. Liable For Deficiency In Service
1 year, 1 month ago

Failure To Reimburse Full Amount, Kurukshetra District Commission Holds Bajaj Allianz General Insurance Co. Liable For Deficiency In Service

Live Law  

The District Consumer Disputes Redressal Commission, Kurukshetra bench comprising Dr Neelima Shangla, Neelam and Ramesh Kumar held Bajaj Allianz General Insurance Company Limited liable for deficiency in service for failing to reimburse the full amount of vehicle repair expenditure incurred during a hit and run case. Kamboj owned a car which was insured through an online policy issued by Bajaj …

Karnal District Commission Holds New India Assurance Co Liable For Deficiency In Service, Directs To Disburse Rs. 1.48 Lakhs, Pay Compensation
1 year, 2 months ago

Karnal District Commission Holds New India Assurance Co Liable For Deficiency In Service, Directs To Disburse Rs. 1.48 Lakhs, Pay Compensation

Live Law  

The District Consumer Disputes Redressal Commission, Karnal bench comprising Shri Jaswant Singh, Shri Vineet Kaushik and Dr Suman Singh held New India Assurance Company Limited liable for deficiency in service for wrongfully repudiating based on commercial usage of the vehicle. Feeling aggrieved, the Complainant filed a consumer complaint in the District Consumer Disputes Redressal Commission, Karnal, Haryana against the Insurance …

Consequential Diagnosis To Treatment Must Be Reimbursed, Thane District Commission Holds Star Health And Allied Co. Liable
1 year, 6 months ago

Consequential Diagnosis To Treatment Must Be Reimbursed, Thane District Commission Holds Star Health And Allied Co. Liable

Live Law  

Recently, the Thane District Consumer Disputes Redressal Commission bench comprising V.C. Premchandani and Poonam V. Maharshi held Star Health And Allied Insurance Co. Ltd. liable of deficiency in service for rejecting the insurance claim filed by the complainant for expenses he incurred during his treatment at Jupiter Lifeline Hospital Ltd.. Brief Facts of the Case: In 2013, Mr. Diliprao D. …

Chandigarh: Insurer rejects Covid mediclaim over non-hospitalisation, fined
1 year, 11 months ago

Chandigarh: Insurer rejects Covid mediclaim over non-hospitalisation, fined

Hindustan Times  

Denying a Covid-19 patient’s medical claim on the grounds of non-hospitalisation has cost an insurance company dear. Holding Manipal Cigna Health Insurance Company Limited, Chandigarh, guilty of causing the patient mental agony and harassment, the District Consumer Disputes Redressal Commission, Chandigarh, had directed the firm to settle her ₹5,521 claim and also pay ₹10,000 as compensation, apart from ₹10,000 as …

Deficiency In Service: NCDRC Directs ICICI Prudential To Pay Over Rs. 5 Lakh To A Consumer [Read Order]
5 years, 9 months ago

Deficiency In Service: NCDRC Directs ICICI Prudential To Pay Over Rs. 5 Lakh To A Consumer [Read Order]

Live Law  

Apex consumer forum National Consumer Disputes Redressal Commission, while upholding order of District Forum and State Commission, has directed ICICI Prudential Life Insurance Company Limited to pay over Rupees 5 lakh to a Maharashtra resident, whose claim for reimbursement of medical expenses was repudiated by the company. Commission was hearing a revision petition of the insurance company to set aside …

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