Page 42 - Insurance Times September 2019

of the deceased, whose ages would vary. Therefore, the Religare Insurance booked for fake claim
age of the dependants would have no nexus with the com- A 59-year-old woman filed a complaint against Anuj Gulati,
putation of compensation. In the present case, since the MD and CEO of Religare Health Insurance, Vijay Bhaskar,
deceased was 21 years old, the Multiplier of 18 was appli- Religare’s Bengaluru manager and 13 others including doc-
cable as per the table set out in the Sarla Verma case.
tors at Diya Healthcare, for producing fake medical bills on
her insurance policy and claiming it without her knowledge.
Court said the High Court had erred in reducing the no-
tional income of the deceased from Rs. 16,246/- as Rathna Bai, a resident of Vyalikaval, alleged in her com-
awarded by the MACT to Rs. 7,500/. The Court held that plaint that the accused forged medical certificates of her
the deceased was a trained swimmer who had won sev- health checkup and despite knowing they are fake, Dr Vijay
eral State-level competitions. His mother runs a Swim- S, product head of Religare, submitted them to the insur-
ming/Gym Centre at Air Force Station (Central School), ance ombudsman in Bengaluru in June, 2018.
Gurgaon. Therefore, the deceased certainly had the poten-
tial to earn a living by utilizing his skills. “When I bought a health insurance policy from Religare in
2014, I was not asked to undergo a health check up. I did
Age of Deceased, not age of dependent, not undergo treatment. But Dr Vijay along with Ramnique
Sachar, corporate manager, Prashanth Singh, legal manager
Material in Computing Insurance Claim: and Khushpreet Singh, head of claims medical, all from
SC Religare, have helped create fake documents and submit-
ted the same to the insurance ombudsman,” Rathna Bai
The Supreme Court has reiterated the insurance claim prin- said in the complaint.
ciple whereby the computation of claim amount is sup-
posed to be done based on age of the deceased and not “Religare acquired the fake documents from Diya Healthcare
age of the dependents claiming the insurance. in Nandhini Layout. Dr Mary Usha D and Chetan of Diya
Healthcare along with Religare oicials forged the medical
A bench of Justices Indu Malhotra and Sanjiv Khanna was certificates,” she alleged in the complaint. Rathna Bai fur-
hearing Joginder Singh v ICICI Lombard arising out of ther stated that Diya Healthcare’s registration license num-
Himachal Pradesh High Court ruling in an insurance claim ber is not matching the serial number issued by the district
that the courts below failed to award compensation to- health oicer in Bengaluru and that it was not renewed.
wards Future Prospects and Loss of Estate. Court accord-
ingly granted compensation under these additional heads. There are no records, neither in Karnataka Medical Council
nor in Medical Council of India, about the registration of Dr
Mary Usha D. There are no documents regarding the regis-
In a recent 2019 judgment in Royal Sundaram Alliance In-
tration of Diya Healthcare as well. The accused showed that
surance Co Ltd. v Mandala Yadagari Goud & Ors, the apex
court has settled that the Multiplier has to be applied on Rathna Bai had undergone medical treatment at Diya
the basis on the age of the deceased. Court quoted itself Healthcare, with documents attested by the doctors there.
from Royal Sundaram: “We are convinced that there is no Even Bai’s signature was forged. Khushpreet Singh, head,
claims medical, Religare Health Insurance, contacted Bai’s
need to once again take up this issue settled by the afore- daughter and oered 15% commission to clear the insurance
said judgments of three Judge Bench and also relying upon claim, which she rejected. Mohamed Asraf Khan, zonal
the Constitution Bench that it is the age of the deceased head of Religare in Koramangala and Mohammed Noorulla
which has to be taken into account and not the age of the had submitted a fake consent letter from Vikram hospital,
dependents.” The erroneous multiplier of 11 to calculate Bai learnt in July, 2018. T
claim amount was thus modified to a Multiplier of 18.

Ans. of August'19 Insurance Quiz contest
Court also held the “lump sum amount of Rs. 25,000/- to-
1. Reliance General Insurance
wards loss of love and affection” as inaccurate computa-
tion since in 2017, the apex court in Magma General In- 2. Ganesh K
surance Co. Ltd. v. Nanu Ram & Ors had held that a sum 3. Ranjan Gogoi
of Rs. 40,000/- is to be paid to each of the parents towards 4. Citigroup
loss of consortium on the death of a child. The gross sum 5. Satishwar Balakrishnan
of the insurance amount thus stands enhanced by the Su- 6. Aviva Income Suraksha
preme Court. 7. GEICO

42 The Insurance Times, September 2019