Ahmedabad Ombudsman Center

Case No.11-005-1207-12

Mr. Urvishbhai A. Patel 

Vs. 

Oriental Insurance Co. Ltd.

Repudiation of Treatment expense Complainant treated for accidental injury of his leg and expense incurred for Rs.26,712/- was repudiated by the Respondent giving reason that there was no evidence to prove the treatment was due to accidental injury.

The policy was not an individual, it is a Group Personal Accident policy issued to a Master Policy holder.

Complainant was a known case of DM and taken treatment for non healing ulcer which is not payable as per policy terms and conditions. 

In view of this, the complaint fails to succeed.

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This entry is part 8 of 17 in the series October 2021 - Insurance Times

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