Insurance claim? Get your commas right
Quote:
A food quality controller who lost his right palm and fingers in a work-related accident was denied claims by his insurer, Life Insurance Corporation. The reason: LIC claimed the policy did not have a certain comma as claimed by the policy holder, and that meant he wasn’t eligible for the money.
However, the State Consumer Disputes Redressal Commission has dismissed LIC’s claims, awarding the executive his policy amount of Rs 45,000, plus a compensation of Rs 2,000 and Rs 5,000 towards legal costs. Sanjay Poojary was covered by LIC’s two Jeevan Mitra insurance policies, providing him with a total cover of Rs 45,000, which included an accident that would cause him to lose his “right hand at or above the wrist”.
In July 1994, Poojary – who worked with Nashik’s Classic Foods Ltd – met with a crippling accident at work. His right palm was crushed by a machine he was working on, due to which his middle finger, ring finger and pinky had to be amputated. This also rendered his two remaining fingers immobile. But when Poojary sought claims from LIC, he was refused.
Poojary’s lawyer, Uday Wavikar, moved the Nashik Consumer Forum which, in September 1998, asked the LIC to pay Poojary Rs 45,000 and Rs 2,000 as compensation.
In their appeal filed before the commission against the forum’s order, the LIC argued against granting any benefit for Poojary by citing clause 10 (b) of the policy. It states that accidental injuries, which within 90 days of the incident, lead to irrecoverable loss or “amputation of both hands at or above the wrist, or in the amputation of both feet at or above ankles, or in the amputation of one hand at or above the wrist, and one foot at or above the ankle, shall also be deemed to constitute such disability”.
The LIC contended that the consumer forum misread the provision, as there is no comma after ‘the wrist’, which actually means that Poojary would only be eligible if he were to lose one hand and one foot.
Dismissing LIC’s appeal, the commission asked it to pay an additional Rs 5,000 towards Poojary’s legal costs.
“It’s not that to cover the disability for which the insurance claim could be awarded, there should be simultaneous amputations of one hand and one foot,” the commission observed.
“Whether there is a comma or not after the word ‘wrist’ is irrelevant,” it noted, adding that in any case, the comma exists as per the policy’s copy.
Source - economictimes.com
