Ahmedabad Ombudsman Centre 

Case No. 11.002.0225 

Smt. Daxaben R. Vaghela 

Vs 

The New India Assurance Co. Ltd. 

The Complainant had a vehicular accident resulting in hospitalisation and surgery, which was not disputed. The Complainant claimed TTD for 202 days while the Respondent offered to settle the same for 51 days. It was observed that after 51 days from the date of accident, the Complainant’s employer directed her to join office for some emergency requirement and that she attended office for 10 days. Due to non-union of the fracture, she had to be hospitalized again and further operations were carried out. 

Thus, she was temporarily bedridden for another 71 days after which she had again to join duties for 4 days on receiving an emergency call from her employer. The second operation could not unite the fracture necessitating a third operation. She was incapacitated again, now for another 95 days. 

Since the Complainant did not join duty but was recalled for some unavoidable purpose and since three successive operations had to be conducted for the same accident and since the Respondent’s own Medical Referee opined payment of TTD for the full period, the Respondent was directed to pay TTD for all the days when she was incapacitated.

Series Navigation<< Hyderabad Ombudsman Orders Insurance Claim Settlement: Procedural Objections OverruledExposure Draft of Insurance Regulatory and Development Authority of India (Preparation of Financial Statements of Insurers) Regulations, 2017 >>

Author

This entry is part 9 of 19 in the series May 2017

Byadmin

Leave a Reply

Your email address will not be published. Required fields are marked *