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.
