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Your health information is confidential;Doctors unethical if pass information to Insurance Companies

An interesting case was decided by the National Consumer Forum in February this year. Life Insurance Corporation of India (LIC) had rejected a claim requested by the kin of PR Sumanagala post his death, on the basis of his medical records and a medical attendant’s certificate. LIC rejected the claim stating that “the insured was a diabetic patient for the past 15 years and was undergoing irregular treatment.” To justify their claim, the company produced a discharge summary and the treatment records supplied by the Holy Ghost Mission Hospital where Sumanagala had died. They also produced a medical attendant’s certificate that confirmed acute renal failure as secondary cause of death and long-standing diabetes as the primary cause. On the other hand, Sumanagala’s wife continued to insist that her husband was totally healthy when he had taken the policy and that they learnt about his condition only after he was admitted to the hospital....

New windows opening in favour of Home Buyers; Developer in leaning mode

In civil appeal No. 3778 of 2020 in the Supreme Court before the bench of M.R. Shah; B.V. Nagarathna, J in case of Amit Katyal V/S Meera Ahuja & others, Apex court allowed withdrawal of Corporate Insolvency Resolution Process (CIRP) against a builder in an application filed by three homebuyers in view of a settlement plan agreed upon by the majority of them. In the larger interest of the homebuyers, the apex court exercised power under article 142 to permit withdrawal of the CIRP proceedings and set aside all matters pending between the parties,this order is passed on March 03, 2022 Apex Court held- Insolvency and Bankruptcy Code, 2016 - The object and purpose of 14 the IBC is not to kill the company and stop/stall the project, but to ensure that the business of the company runs as a going concern Dr Prem Lata ,Legal Head VOICE...

Telecom matters back to Consumer Commissions

Supreme in civil appeal no 7687 of 2004 in the case of GM Telecom V M Krishanan barred the jurisdiction of consumer foras and held that such disputes will be decided by arbitrator under section 7B of Indian Telegraph Act .The award so made shall be final and not open to challenge before any court /forum The arbitrator shall be appointed by the Central Govt either specifically for determination of referred dispute or generally for the determination of disputes under this section. Apex court has further remarked that it is a well settled law that special law overrides the general law In that context, a two-Judge Bench of this Court thus held “In our opinion when there is a special remedy provided in Section 7-B of the Telegraph Act regarding disputes in respect of telephone bills, then the remedy under the Consumer Protection Act is by implication barred”...

Information about the incident in insurance matters –an essential factor

In this case had three issues to resolve when theft of vehicle is informed late 1. Temperary registration of the vehicle had expired 2. Delay in intimation of theft 3. Left vehicle unattended breaching condition of the insurance · On the issue of delay in information about theft ,FIR was duly filed before the police ,state machinery was brought in motion. Complainant prefereed to wait for the outcome of police verification and filed claim after police issued no trace certificate . · As per National commission observations ,expiry of temporary registration is a subject matter of motor vehicle act and insurance is to nothing to do with it. Vehicle is temporary registered and permanent registration is to take process · Vehicle was parked outside the guest house which was in a residential area and that was the only system of oarking vehicles and it could not be said to be left unattended in any manner All the things were well explained and justified ,hence there was no point to repudiate its claim ....

Revisional Jurisdiction of Consumer Commissions to be exercised carefully

Revision is mainly on the point of jurisdiction of the court /forum and higher court is not to look into the matter in detail about facts ,evidence etc .This remedy can be invoked even before any order passed by the lower court/forum if forum had no juridction to deal with the case and while exercising the revisional jurisdiction ,higher court may issue appropriate directions also to the lower court /forum...

How to draft consumer Complaint

As per procedure the basic complaint or petition must incorporate all relevant facts in chronological order with supportive documents and that is the base which is considered as grievance of complainant. When opposite party files written statement, nothing more can be added to the complaint because opposite party has replied to the complaint and has availed the opportunity to defend grievance against him. Anything added further will not form the part of complaint. Replication is a stage when complainant can at the best say something on written statement filed by the opposite party. It may be again emphasising the version in the complaint or reiterating the facts elaborated in the complaint or saying denial by the opposite party is wrong. Sometimes for the purpose of reiterating his stand complainant can file some document which supports the basic complaint only and not the new thing or anything beyond complaint. Document or fact given at this stage if not relevant are not considered while making order....

“Class Action” theory under new Consumer Protection Act 2019

law laid down by Supreme Court for “Class Action” character as a consumer Complaint thus stands as hereunder- 1. There should be an element of sameness of the interest and with common interest of all the consumers joining together. 2. The complaint should be represented by one leading case for protection of interest& benefit of all the consumers. 3. Factually different cost,size ,booking date and price variation will not affect the character of “class action” against the same party with the same objective held Supreme Court. 4. The content of the complaint must also not be a single party centric it should speak for all the consumers....

Death by mosquito bite is an accidental death, says National Commission

Justice V K Jain also referred to a Consumer Complaint No. 223 of 2006, Shri Matber Singh v. Oriental Insurance Co. Ltd., IV (2014) CPJ 126 (NC) decided on 5.9.2014 and noted that an accident may include events like snake bite, frost bite and dog bite. Hence, it was held that malaria due to mosquito bite is not a disease and very well could be termed as an accident Claim of the complainant was directed to be paid in the above terms and observations...

Builder to pay additional taxes to Corporation on behalf of Home buyers

It’s a common grievance of home buyers that builder fails to complete the construction work including amenities as per plan and agreed terms. With the result occupancy certificate is not issued by the concerned authorities. In some cases home buyers take possession under compelling circumstances with incomplete work and occupancy certificate still remains a problem. Here is a unique case decided by the Hon’ble Supreme Court on 11th January 2022 which gives a new dimension to the issue of fixing liability of Developer when occupancy certificate not provided to the home buyers....

IRDA Guidelines -Delay in claim intimation/submission of documents to insurance

Insurance Regulatory and Development Authority has issued a circular dt 20.9.2011 vide their reference no –IRDA/HLTH/MISC/CIR/216/09/2011 wherein certain guidelines have been issued for condoning the delay in claim intimation /documents submission with respect to all life insurance contracts and all non-life individual and group insurance contracts while settling the claims of the insurers.It is particularly pin-pointed that- “the current contractual obligation of the insured to intimate the company or submit the papers within specific time is for the purpose of investigation,loss assessment etc but this condition should not prevent genuine claims when delay is due to unavoidable circumstances”.It further states that- “insurers decision to reject the claim shall be based on sound logic and valid grounds,be noted such limitation clause does not work in isolation and is not absolute.” At the end INSURERS are advised “to incorporate additional wordings in the policy documents ,suitably enunciating insurer’sstand to condone delay on merits for delayed claims when delay is proved to be for reasons beyond the control.”...

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