Page 48 - Insurance Times January 2018 Sample

LEGAL

Group Personal Accident

Ahmedabad Ombudsman Center FINDINGS
The insurer submitted that Company was intimated about
Case No.11-005-1207-12 the death of late (Shri) Gurdev Singh after seven months,
which was in violation of the policy term and condition. He
Mr. Urvishbhai A. Patel
clarified that considering hardship being faced by the fam-
Vs. ily of the deceased, a liberal view has been taken and claim
was settled on sub-standard basis by paying 75% of the
Oriental Insurance Co. Ltd. admissible amount. Complainant represented that family

was in a state of shock, even then necessary documents
Repudiation of Treatment expense Complainant treated for were produced for a claim.
accidental injury of his leg and expense incurred for
Rs.26,712/- was repudiated by the Respondent giving rea- DECISION
son that there was no evidence to prove the treatment was It was held that penalizing a widow for the delay caused in
due to accidental injury. lodging claim is notjustified as reasons for the delay in com-
municating the claim were spelt out by the widow. Accord-
The policy was not an individual it is a Group Personal Acci- ingly, an award was passed with a direction to the insur-
dent policy issued to a Master Policy holder. ance company to release the balance payment of Rs.
Complainant was a known case of DM and taken treatment 25,000/-.
for unhealing ulcer which is not payable as per policy terms
and conditions. Guwahati Ombudsman Centre
In view of this, complaint fails to succeed. Complaint No. 11-G8-059/12-13
Mrs. Jaya Deka
Chandigarh Ombudsman Center Vs

Case No. GIC/324/REL/11/11 The Reliance General Insurance Co. Ltd.
Raj Kaur Complainant: The Complainant stated that her husband Mr.
Kashab Deka was an insured member under Personal Acci-
Vs
dent Insurance Policy (Group) bearing Policy No.
Reliance General Insurance Company Ltd. 1503302914000026 procured from the above Insurer by the
Employer GTFS Multi Services Limited covering the period
FACTS from 29.05.2010 to 28.05.2011. While the policy was in
The complaint was filed about Group Personal Accident force, the Insured met with a motor accident on 03.02.2011
Policy that covers police personnel. Complainant’s husband, and succumbed to his injuries on 09.02.2011. Thereafter,
late (Shri) Gurdev Singh, insured under the policy for Rs. she lodged a death claim before the Insurer along with all
1,00,000/- had died in a road accident on 22.04.2009 and supporting documents. But, the Insurer has repudiated the
its claim was settled by the company for Rs. 75,000/- only. claim without any justified ground. Feeling aggrieved, the
Hence, feeling aggrieved, she had approached this office Complainant has lodged this complaint.
for release of remaining balance amount. Insurer : The Insurer has stated in their “Self Contained

48 The Insurance Times, January 2018

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