Sunny side up

The market value of emerging-market stocks may surge more than fivefold to $80 trillion in two decades, overtaking developed nations, as China becomes the world's largest stock market.

Read Article...

User

Peeved by rejection of claim, top Chartered Accountant Bansi Mehta wants winding up of New India Assurance

Despite winning a case against the insurer at a Consumer Forum, Mr Mehta’s claims still remain to be settled. If the insurer does not pay within the stipulated time, he may file a winding-up petition against the company

Hell hath no fury like an insured person scorned. Or that is what public sector insurance behemoth New India Assurance has realised, and it now may face a suit which wants the winding up of the company due to non-payment of a claim of Rs1,47,989.29.

Chartered accountant Bansi S Mehta has said that he had won a case in the Consumer District Redressal Forum against the New India Assurance Co. Despite several reminders, the insurer still has not paid his claim. On 25 August 2010, he sent a final notice to New India Assurance saying that if the insurer fails to pay his dues within 21 days, he will initiate legal proceedings against it. In the notice, Dhiru & Co, solicitors for Mr Mehta said: "Our client will be constrained to take out appropriate legal proceedings against you including presentation of a winding up petition in the Bombay High Court, for the costs and consequences of which you will be solely responsible".

The case relates to a mediclaim policy (No.110900/34/06/00011124) bought by Mr Mehta for his wife from New India Assurance. The policy was valid from 12 February 2007 to 11 February 2008.

In December 2007, Mrs Mehta consulted Dr Anand B Modi, surgeon, and she was subsequently diagnosed with 'umbilical hernia with divarication of recti'. She was operated upon in February 2008 at Cumballa Hill Hospital, south Mumbai.
Mr Mehta then lodged a claim of Rs1,47,989.29 with the third party administrator (TPA), Paramount Health Services on 29 February 2008. Paramount rejected the claim, on the grounds that Mrs Mehta suffered from a pre-existing ailment and was hence not eligible for medical reimbursement. Mr Mehta filed a case against the insurer before the South Mumbai District Consumer Dispute Redressal Forum. However, the insurer failed to appear before the Forum for any of the hearings. In its final order, the Forum directed New India Assurance to pay Mr Mehta the contested amount along with a penal interest @6% per annum from the date of complaint to the date of payment of full claim.

According to the solicitors, New India Assurance finally replied on 26 April 2010, saying that it had appointed Ms Deepa Kulkarni to depose in front of the Forum on the insurer's behalf. Ms Kulkarni was supposed to file a petition for restoration of the matter. The solicitors have submitted that no such petition has been filed by New India Assurance upon Mr Mehta.

After another petition by Mr Mehta, the Consumer Dispute Redressal Forum issued a Certificate of Recovery and forwarded a copy to the Collector, Old Custom House, Mumbai for taking necessary steps for the recovery of the claim amount along with the penal interest.

However, New India Assurance has not yet made the payment to Mr Mehta. As a final resort, Mr Mehta's solicitors have slapped a notice against the public sector behemoth saying that they might move the Bombay High Court for legal proceedings, which would include a prayer for a winding up petition against New India Assurance.

What begs the question is why does a consumer have to run from pillar to post to get redressal for his grievances? Despite a clear order from a Consumer Forum, New India Assurance has chosen to maintain a deafening silence.

And though justice may finally be done as far as Mr Mehta is concerned, it will be much delayed. Indeed, Indian insurance companies were nationalised decades ago because they were supposed to carry out their duties as far as social responsibility is concerned. If these public sector insurers do not work for the public good, who will?     

User

COMMENTS

Achyut Patel

6 years ago

It is regrettable for waiting so long to file the case for recovery and even winding up petition in Bombay High Court. Should have proceeded immediately after the given notice time expired. Is Bansibhai dragging his feet now? If not then why the silence for so long?

Biyani

6 years ago

The over all situation of Medical Insurance is pathatic [unless you are one of those unscruplous people who successfully swindle the Insurance Company].
It is pity that such things can happen to a person of the stature of Shri Bansi Bhai; one can imagine what will happen to a common man.
Insurers are handling this business as if they are obliging the insured.
In this whole gamout a honest insured continues to suffer.
They blatantly refuse even to provide a TPA of customer's choice. Some thing where they don't have to spent a penny.

Amit

6 years ago

21 days from 25th August 2010 is now over. Has Mr.Mehta got his claim cheque?

sameergala

6 years ago

kudos to Mr mehta & I am with the opinion with Mr.Kumar as to what is the role of IRDA as a regulator????

REPLY

PPM

In Reply to sameergala 6 years ago

IRDA is here to help the insurance company. At last, the cairman of IRDA will tell NIA that no need to listen to any court - consuer or legal.

IRDA is here to support them..so keep on (mis)selling the policies and IRDA with Finance Minister as their god father.

DHARMENDER HARITISH

6 years ago

IS NOT TOO MUCH 4 A SMALL OPERATION WHICH GIVES MUCH LOSS TO INSURANCE CO. ONLY HOSPITALS ARE IN PROFIT. TODAY ONLY TWO BUSINESS ARE PROFITABLE ONE IS HOSPITAL& 2nd EDUCATION NO LIMIT OF FEE .BOTH FORGET THEIR PLEDG (OTH).

A Kumar

6 years ago

The case of Mr Mehta needs to go much beyond just a monetary settlement, as I am sure must have been his intention where he probably spent much more in time value than the claim he will eventually get. The first question is what was the role of IRDA in the entire incident? Had Mr Mehta gone to the IRDA? If not why not? Is everyone supposed to ignore the sector regulator and go to consumer courts? For a banking complaint should one first go to the banking Ombudsman or the court? Perhaps Mr Mehta knew what his fate would be if he went to the regulator. If government accepts this view they should do away with Sector regulators.
The fact is that such incidents are far too common, particularly with Insurance. Most claims are not paid or are only partially paid. Customers, pressed for time, have no desire in each case to go to consumer or other courts, it is simply not worth it.
But this brings out the role of the IRDA in the entire setting. Can they ask the Insurance companies what percentage of claims are denied or accepted by each company and put the information on their website? At least the people will know what to expect. They also need to carry out their own investigations and impose class penalties on the company if this is the only way the sector can be reformed.

Achyut Patel

6 years ago

It is very disgusting and a lesson should be taught to the defaulters.

malq

6 years ago

Bansi Mehta ki Jai Ho. People like him with resources of the legal assistance sort should take this to the logical conclusion, and then such episodes should become regular citations for other victims who may not have the wherewithal to fight their own cases. Thank you for publishing this article. You could also consider publishing the names and full designations of ALL the officials from the insurance company, for posterity, on the website as part of the article or as an addendum

The sun is setting

Japan's economic woes are far from over. And petty political squabbles are not helping the country either.

Read Article...

User

We are listening!

Solve the equation and enter in the Captcha field.
  Loading...
Close

To continue


Please
Sign Up or Sign In
with

Email
Close

To continue


Please
Sign Up or Sign In
with

Email

BUY NOW

The Scam
24 Year Of The Scam: The Perennial Bestseller, reads like a Thriller!
Moneylife Magazine
Fiercely independent and pro-consumer information on personal finance
Stockletters in 3 Flavours
Outstanding research that beats mutual funds year after year
MAS: Complete Online Financial Advisory
(Includes Moneylife Magazine and Lion Stockletter)