The apex consumer court has asked insurance companies to provide the terms and conditions of a policy to its customers along with the policy certificate to reduce litigation. The National Consumer Disputes Redressal Commission (NCDRC) gave the direction while asking the National Insurance Company Limited to pay the entire amount of a mediclaim and pay Rs 50,000 as compensation to an 83-year-old West Bengal resident J R Banik who had undergone treatment for brain haemorrhage. The NCDRC also said that insurance agents, in order to achieve a target of number of insurance polices, act in “haste and collect premiums”.
“The complainant (Banik) was never supplied the terms and conditions of the policy, otherwise he would have opted (for) medical treatment within four corners of the terms and conditions of the policy. “It appears that the agents of insurance companies to achieve a target of number of insurance policies, act in haste and collect premiums,” the apex consumer bench, headed by presiding member S M Kantikar, said.
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“The consumers are supplied either a cover note only or the insurance certificate without any policy clauses or terms and conditions. If the insurance companies take a little pain to provide terms and conditions alongwith the policy certificate, then there will be limited scope of litigation,” the bench added. According to the complaint filed by Banik, he took a mediclaim policy in 2007 and alleged that the company issued insurance certificate with a coverage of medical insurance upto Rs one lakh but failed to issue the terms and conditions of the policy.
It said he had suffered brain haemorrhage and paid a sum of Rs 87,773 for the treatment. The cost was partially rejected by the insurance company which paid only Rs 64,360. The firm contended that the complaint was not maintainable as the deduction was strictly in accordance with the terms and conditions of the policy. The district forum allowed the complaint and asked the firm to pay the balance amount of Rs 23,373 along with a compensation of Rs 50,000 for the harassment and Rs 5,000 as legal cost. However, the state commission allowed the appeal of the firm and set aside the district forum’s order against which Banik approached the apex commission and got relief.