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 realized, and it now may face a suit which wants the winding up of the company due to non-payment of a claim of Rs. 1,47,989.29.

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 nationalized 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?

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Category : CA, CS, CMA (3525)
Type : Judiciary (10123)

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