July 14: The consumer court has hauled up a major insurance firm for its attempt to deprive one of its clients of his claim for medical expenses following a bypass surgery.

The Oriental Insurance Company Limited (OICL) was found resorting to ``deliberate mischief'' in the mediclaim policy (July 9, 1986-July 9, 1987) issued to Altamount Road resident H J Chhabria. The court has directed OICL to pay Chhabria 18 per cent interest on Rs 37,800 from March 1, 1990 .

In February 1987, Chhabria suffered from ischemic heart disease. OICL reimbursed the expenses on preliminary angioplasty hospitalisation.

On May 5, 1987 Chhabria wrote to OICL that he was advised immediate bypass surgery which he was trying to avoid by trying alternate therapies. If unavoidable, he would claim medical expenses from them.

On June 24, 1987, when Chhabria went to renew his policy, he was made to fill a fresh proposal form upon which a rubber-stamp was affixed. His cheque for the premium was dated June 23, 1987.

Chhabria was operated on August 6, 1987. In November 1988, Chhabria claimed Rs 61,825 as medical expenses. IOCL avoided payment. Dejected, he approached the Consumer District Redressal Forum alleging that OICL had issued a fresh policy with effect from July 13, 1987 which excluded ischemic heart disease.

Chhabria's advocate Jehangir Gai alluded to the ``mischief'' played by IOCL in affixing a new stamp dated July 13, 1987 upon the stamp dated June 24, 1987 on the proposal form.

Gai argued that there was no need for a fresh proposal as renewal is automatic. A break, i.e. policy issued from July 13, 1987-July 12, 1987 (second policy), anticipating a claim in view of Chhabria's May letter was `malafide'.

OICL's lawyer Geeta Handa Khanuja countered that Chhabria had contracted the disease within 30 days from the date of commencement of (`second') policy, July 13, 1987. Even a lapse of one day is considered to be a fresh policy. IOCL had full right to exclude it while issuing a fresh policy.

In an attempt to subvert Chhabria's claim, the insurance company filed four affidavits which were found contradicting each other. The first filed in October 1995 by assistant divisional manager (ADM) M Paingankar acknowledged that the cheque was received on June 24, 1987. He explained that procedurally whenever a fresh proposal is received, a stamp is sealed. Only when the policy is accepted is a signature affixed. In this case, it was July 13, 1987.While the then DM Srinivas Shanbag said that the proposal was received on July 13, 1987, initialled and accepted immediately. The present DM J K Shah acknowledged that the cheque was dated June 23, 1987 but Chhabria presented it only on July 13, 1987.

The last affidavit was filed again by Paingankar on February 13, 1997. The court refused to take on record. However, it was accepted for a limited purpose, as Paingankar now stated a computer error had crept in his earlier affidavit. What should have read as "On the June 24, 1987, the cheque for the premium was not received." read "On the June 24, 1987 the cheque for the premium was received." President R J Purandare and member G N Shenoy held that Paingankar, who has signed the affidavit in the presence of the notary, would have corrected the mistake before affirming it. This was an afterthought, they concluded.

Copyright © 1997 Indian Express Newspapers (Bombay) Ltd.