Insurance firm asked to pay compensation

NEW DELHI NOV. 7. It took her seven years to get the "claim'' she deserved. Forced to go in for an emergency operation, this Delhiite found that instead of covering her bills, her insurance company forced her to go to court.

Being safe does not always pay as Prakash Wati Gupta -- who had a joint policy with her husband Shyam Behari Gupta -- realised. And often insurance companies can be promise-breakers. Though she took all the precautions to be safe in case of an emergency, Ms. Gupta found that her insurance firm -- Oriental Insurance Company -- did everything except what she paid the premium for.

On the basis of a complaint filed by Ms. Gupta, a New Delhi Consumer Court has now found the insurance company guilty of "deficiency of service'' and directed Oriental Insurance to pay Rs. 19,162.65 at 9 per cent interest from the date of lodging the complaint till the date of realisation, together with litigation costs.

Rushed in for an emergency operation to a nursing home at Janakpuri here for a distended gall bladder, Ms. Gupta completed all the formalities required by the company but found that it rejected her claim on the grounds that the operation was "pre- planned'' as she was suffering from these symptoms for a while earlier.

The company also submitted that the claim was not payable as the nursing home where Ms. Gupta had been operated did not have more than 15 beds and was not registered with Delhi Administration. The nursing home was also far away from the Gupta's house and therefore the operation was not an emergency, the company claimed.

A bench of the New Delhi Consumer Court, presided by L.C Jain, rejected the submissions made by Oriental Insurance and held that the company had no evidence to support its claims. It also stated that the nursing home being far away did not matter as hospitals depend on the faith of family members. Besides, in a city like Delhi, Paharganj to Janakpuri cannot be considered far away.

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