Claim settlement can't be disputed once payment is accepted

Goolrokh Mehta and her daughter, Zenia were insured under a mediclaim policy issued by New India Assurance. During its subsistence, Zenia was admitted to Holy Spirit Hospital for abdominal pain. The hospital bill and treatment cost came to Rs 53,022. An insurance claim was lodged for this amount, with supporting bills Stock Market Tips

Health India, the third-party administrator (TPA), processed the claim and sanctioned only Rs 22,623. A cheque for this amount was sent to Goolrokh, with a covering letter stating the amount was being paid in full and final settlement, and acceptance of the cheque would discharge the insurance company of all liability. The letter further stated that in case the insured did not agreed with the amount being paid, the cheque should be returned within 10 days Nifty Trading Tips

Goolrokh's husband sent a letter, demanding an explanation as to how the claim had been computed. He got a reply giving a detailed calculation. Not satisfied, Goolrokh and Zenia filed a complaint against the insurance company and the TPA, contending that certain amounts had been illegally and arbitrarily disallowed, a deficiency in service and an unfair trade practice. They stated the cheque for the settlement had been accepted "without prejudice", and they were entitled to claim the balance amount. They also demanded compensation of Rs 2 lakh and costs of Rs 30,000.

The insurance company contested the case, saying the complaint could not be filed as payment was received and full and final discharge had been given. Upholding this contention, the South Mumbai District Forum dismissed the complaint Financial Astrology Trading Tips

Mehtas challenged this order in an appeal before the Maharashtra State Commission. They argued that a sealed envelope was received on October 24, 2011, receipt of which was acknowledged. On opening the envelope, they found that it contained a discharge voucher and a cheque for Rs 22,623 along with a counterfoil. Goolrokh's husband had sent a letter on November 11, 2011, informing the TPA that this cheque was being accepted on a "without prejudice basis", as it was less than the claim amount. Certain deductions had been illegally and arbitrarily made, in contravention of the terms. Since the cheque had been accepted without prejudice to their rights, its acceptance would not prevent them from disputing the computation and claiming the balance amount Inytraday Trading Tips

In its judgement of October 29, 2014, delivered by Dhanraj Khamatkar for the bench along with R C Chavan, the Maharashtra State Commission observed the discharge voucher clearly stated: "Kindly note: acceptance of the above mentioned cheque by the insured is in full and final settlement of the claim and the insurer stands fully discharged of liability under the mediclaim policy". The cheque counterfoil also states: "In case you do not agree with this payment, kindly return this cheque to us within 10 days. The retention of the cheque and/or encashment of the cheque will automatically be deemed as full and final settlement of your claim". Neither document had any endorsement that the amount was being accepted without prejudice. The subsequent letter was an afterthought, and could not be considered. Hence, the State Commission concluded the Mehtas had accepted the amount in full and final settlement Personal Numerology Trading Tips

The Mehtas then attempted to argue that discharge had been obtained through fraud and misrepresentation. The State Commission rejected this argument, as there was not an iota of evidence to substantiate this. The Commission dismissed Mehta's appeal, concurring with the view taken by the District Forum that a complaint could not be filed after having accepted the claim and given discharge.

Hence, consumers should be careful about the inference of "implied discharge". They should promptly record their protest, reserving their right to take recourse to legal action for the balance claim amount Commodity Trading Tips