Vadodara: ‘Stabbed woman a victim not participant in crime’

VADODARA: In an important judgement, a consumer court in Vadodara chastised a state-run insurance company for denying mediclaim to a woman stab victim, observing that she was a ‘victim’ of the crime and not ‘a participant’ as claimed by the insurer.
New India Insurance Company and the third-party administrator (TPA) turned down Rs 2.5 lakh hospital bill of Alpa Patel, who was stabbed by two persons who were contracted by her husband Sunil, who plotted the crime as he had extra-marital affairs.Sunil was, however, not named in the FIR.

Directing the insurer to pay the entire treatment expense of Rs 2.5 lakh along with interest to Patel, the additional Vadodara District Consumer Disputes Redressal Forum said that the company had been “unfair” with the woman by misinterpreting its own clause.
“A person injured in a criminal act is also eligible to get treatment money from the insurance company if the person is a victim in the case,” the court observed.
After settling the bill of a private hospital in Chhani where she was treated, Patel submitted the documents including the copy of FIR to the TPA M/s Vipul Medicorp TPA Pvt Ltd. But the TPA rejected the claim citing the clause that any injury or illness sustained whilst or as a result of participating in any criminal act is not payable. Patel then approached the consumer forum against the insurance company and TPA to get her claim amount.
Patel, a resident of Mehsananagar in Nizampura, was stabbed on February 20 of 2015 when she returning home after buying milk. She underwent treatment for over a week.
The court upheld that though the policy is in her husband’s name, Patel is also an insured person as a joint holder of the policy. Thus, she was not a participant in the crime, but a victim of it, the court stated. As a victim, she is eligible to get the entire amount of her treatment, said advocate P V Moorjani, who represented her.
“We argued that Patel had taken the policy in 1999 and renewed it every year while the clause of a criminal act was brought in later,” Moorjani said. “Since the clause was issued by the insurance company in 2002, it cannot be enforced on an existing policy,” he added.