IFFCO-Tokio General Insurance Asked To Pay Rs9.87 Lakh Cost for Medical Treatment
Moneylife Digital Team 21 February 2024
While upholding orders passed by the Gautam Buddha Nagar district consumer disputes redressal forum and the Uttar Pradesh state consumer disputes redressal commission, the national consumer disputes redressal commission (NCDRC) directed IFFCO-Tokio General Insurance Company Ltd to pay Rs9,87,639 as hospitalisation and medical treatment cost after the policyholder met with an accident. NCDRC, however, set aside the compensation of Rs50,000 awarded by the district forum for mental agony and harassment.
 
In an order earlier this month, the NCDRC bench of air vice-marshal (AVM) J Rajendra (retd) (presiding member) says, "The district forum issued a well-reasoned order based on evidence and arguments advanced before it. The state commission, after due consideration of the pleadings and arguments, determined that no intervention is warranted on the district forum's order. This was primarily because the grounds relied upon in the repudiation letter are not supported by leading any cogent and convincing evidence with regard to the complainant was under the influence of alcohol at the time of the accident."
 
Gautam Buddha Nagar, Uttar Pradesh-based Shishir Bhatnagar, bought a Rs10 lakh Medishield insurance policy from IFFCO-Tokio General Insurance by paying a premium of Rs13,820. The policy was valid for one year, from 5 November 2010 to 4 November 2011. However, during the subsistence of the policy, he met with an accident, was hospitalised and incurred expenses of Rs9,87,639. 
 
His insurance claim was rejected by IFFCO-Tokio General Insurance, saying that Mr Bhatnagar was under the influence of alcohol at the time of the accident. Being aggrieved, he filed a consumer complaint before the district forum.
 
While allowing the complaint, the district forum directed IFFCO-Tokio General Insurance to pay Rs9,87,639 with 8%pa (per annum) and Rs60,000 towards mental agony, physical pain and litigation expenses. 
 
IFFCO-Tokio General Insurance, aggrieved by the order, filed an appeal before the state commission. While dismissing the appeal, the state commission observed that "The main contention of the counsel for IFFCO-Tokio General Insurance is that when the insured person (Mr Bhatnagar) was admitted to the hospital after the injury, a note was made that he was in an alcoholic state. No affidavit from the concerned hospital doctor has been submitted to prove this report, also, no medical test has been done to prove the presence of alcohol, so this report cannot be considered reliable. Again, on the basis of this report, it is not even sure how much alcohol was to be taken. This report does not provide evidence that Mr Bhatnagar lost control of his discretion due to the consumption of alcohol, so there is no power in this argument. Therefore, there is no ground to interfere with the decision or order passed by the district consumer commission. Appeal is liable to be dismissed."
 
After examining the pleadings and associated documents placed on record, including the orders issued by fora below, NCDRC noted that the scope for revision under section 21(b) of the Consumer Protection Act, 1986 and now under section 58(1)(b) of the Consumer Protection Act, 2019 confers very limited jurisdiction on the commission.
 
Referring to observations made by the Supreme Court in three judgements, AVM Rajendra (retd) says he does not find any merit in the revision petition filed by IFFCO-Tokio General Insurance. While dismissing the petition, he modified the order passed by the district forum and set aside the compensation of Rs50,000, saying that multiple compensations for a singular deficiency are not justifiable. 
 
(Revision Petition No1386 of 2022  Date: 9 February 2024)
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