Insurance firm to pay Rs 2.75 L after wrongly denying claim

A consumer forum has asked an insurance company here to pay Rs 2.75 lakh to the owner of a diagnostic laboratory whose machine, insured with it, had got damaged, saying the firm acted "arbitrarily" in denying the claim.
New Delhi Consumer Disputes Redressal Forum, presided by C K Chaturvedi, asked the Oriental Insurance Company Ltd to pay the money to Delhi resident Pawan Gupta on his complaint for reimbursement of the insurance claim for damage to an Ultrasound machine used in his diagnostic lab.
"We have carefully gone through the material on record and find that surveyor having found damaged equipment and its replacement cost etc., is in a perverse manner gone beyond his mandate in not releasing the amount and questioning how machine could be damaged etc....," the forum, also comprising its members S R Chaudhary and Ritu Garodia, said.

The forum said that the company acted "arbitrarily" in rejecting the claim despite surveyor assuming loss of Rs 2.25 lakh on the lower side.
"We hold Opposite Party (company) guilty of deficiency and direct OP to pay Rs 2.25 lakh for the replacement cost as spent for purchase of machine (parts).... We also award compensation of Rs 50,000 inclusive of litigation expenses to complainant," the forum said.
Gupta had told the forum that on December 9, 2009, his Ultrasound machine stopped functioning during examination of a patient.

He called the maintenance engineer who identified the problem and on recommendation, new parts were purchased and bills were presented to the company for insurance claim.

However, the insurance company did not release the amount. Gupta, thereafter, approached the forum alleging deficiency on the part of the insurance company.
The company, however, denied the allegation, claiming that lots of queries of the surveyor were not answered by Gupta.