In two separate cases, a consumer forum has held that unilateral changes made in a Mediclaim policy by the insurance company amounted to deficiency in service. In both cases the forum relied on a Supreme Court judgment which observed that renewal of an insurance policy means repetition of the original policy. “In common parlance, by renewal, the old policy is revived and it is sort of a substitution of obligations under the old policy unless such policy provides otherwise. It may be that on renewal, a new contract comes into being, but the said contract is on the same terms as of the original policy,” the SC had said.
The forum directed The New India Assurance Company Ltd to reimburse Rs 87,186 and pay compensation of Rs 27,000, to Dadar resident Soli Modi. The firm had sanctioned Rs 62,814, instead of the assured sum of Rs 1.5 lakh that Modi had incurred in a hernia surgery in 2012. In the complaint filed before the Central Mumbai District Consumer Disputes Redressal Forum, Soli said on perusing the reasons for sanctioning only a part amount of the claim, it was noticed that the deductions were made on account of changes in the policy terms that were made without his knowledge.
In the second instance, a Dahisar woman who had undergone a hysterectomy in 2011, was sanctioned Rs 22,500 instead of the Rs 1.2 lakh incurred as charges for the surgery and tests. On probing the reason for the part rejection, she learnt that her policy was changed from an Individual policy to a Janta policy without her consent. “The insurance firm and third-party administrator have acted arbitrarily and tried to modify the terms…of the earlier policies issued to her husband. The firm had indulged in unfair trade practices by issuing Janta Policy and under the garb of that policy curtailed the rights of the complainant which were available to her…under the old policies,” the forum said. The woman will get Rs 20,000 compensation and Rs 42,624 reimbursement.