Ahmedabad Ombudsman Centre
Case No. 11.002.0049
Dr. Jaykumar C. Shah
Vs.
The New India Assurance Company Ltd.
Claim under P.A. Policy. Complainant’s wife sustained injury when she fell down from the staircase while climbing it. Respondent offered 3 weeks TTD initially, but revised it upto 5 weeks TTD. However, the Complainant demanded for 6 weeks TTD as recommended by the Treating Surgeon. Complainant pleaded that no reason was adduced by the Respondent for not settling the claim fro 6 weeks TTD. Respondents submitted that their MR recommended for 3 week TTD after physical examination of the insured. On representation from the Complainant they again referred the case to another MR who recommended 5 weeks TTD.
Weightage was given to the treating Surgeon’s recommendation. Allowed 6 weeks TTD.
