Claim halved as biker didn't have helmet on





The Motor Accident Claims Tribunal on Wednesday halved the compensation to be paid to the kin of a biker who died on being hit by a cab in 2009, after it found he was not wearing a helmet at the time of the mishap. While the actual compensation worked out by the tribunal amounted to Rs 12.30 lakh, owing to the biker Jamil Shaikh's (23) contributory negligence, his family was awarded a compensation of Rs 6.15 lakh. The fleet cab company and the insurance firm will additionally have to pay Rs 2.30 lakh in interest.

Observing that the cab driver was not solely responsible for the accident , the tribunal said, "The unfortunate death of the deceased must be attributed to the non-wearing of a protective headgear by him, as his death has been found to have been caused by haemorrhage and shock due to head injury. The deceased should be held to have definitely contributed to his death by not wearing protective headgear while riding a motorcycle on a public road." Shaikh is survived by his wife, mother and a five-yearold son, all of whom filed the application before the tribunal in November 2009. The family alleged that on August 28, 2009, at about 6.15am when Shaikh was riding his bike at Vikhroli, he was hit by the cab, which the family claimed was driven negligently and was speeding.

A case was registered against the driver with the Vikhroli po

lice. The family said that Shaikh worked at an amusement park at Thane and earned a monthly salary of Rs 8,000.

The insurance company submitted that it was not liable to pay the amount as Shaikh had brought upon the accident himself, as he halted without giving any signal or any indication. It alleged that he gave virtually no chance to the driver of the cab to maneuver the vehicle to avert the impact.

The tribunal however, relied on the statement of the

witness who had found Shaikh lying injured by the side of his motorcycle. The witness said the bike was badly damaged at both ends and the cab was damaged in the front. The tribunal observed that the FIR clearly pointed to rash and negligent driving on the part of the cab driver. "I must, therefore, hold that the accident in question was caused on account of the rash and negligent driving of the offending motor taxi and non-wearing of protective headgear by the deceased in breach of the provision of the Motor Vehicles Act," the tribunal said.





Insurance claim's rejection due to `delay' not alright





`Treatment Went On For A Yr After Hospitalization'

A consumer forum has ruled in favour of a woman whose insurance claim was rejected by her insurer because it was filed 416 days after hospitalization instead of within the 30-day deadline.

The forum found that the complainant was under continuous treatment for her injury for more than a year.

It recently chastised National Insurance Co Ltd for repudiating the claim on technical grounds that "cannot be held as just and proper". "The insurance company adopted (an) unfair trade practice," said the South Mumbai District Consumer Disputes Redressal Forum, while directing the firm to pay Worli-based Jyoti Raut the insurance amount of Rs 39,439 along with compensation of Rs 12,000.

Raut was admitted in hospital on February 9, 2010, after she had a fall. When she was discharged the next day, Raut informed the insurer about the fall and the need for hospitalization and requested it for a claim form. She alerted it that as her treatment was on-going she would file the claim upon its completion. This point was iterated in letters on March 9, 2010, and March 7, 2011.

On April 25, 2011, Raut sent a letter claiming expenses incurred on the treatment that continued till March 31, 2011.

Two months later, however, the company repudiated the claim on the ground that the papers were not submitted within 30 days from the completion of the hospital treatment.

Raut lodged many protests with the insurer but when they were ignored she filed a complaint before the forum on July 11, 2012. The insurer, in response, argued there was no evidence to prove her continuous treatment till March 2011. "The last receipt of the doctor's clinic is dated September 9, 2010. It shows the treatment was completed," the company claimed.

The forum however pointed to bills showing that Raut had purchased medicines "on doctor's advice" on five different dates till February 2011.

"The evidence shows the complainant was under treatment till the end of March 2011 and that she incurred an expenditure of Rs 39,439 on treatment," it said.

It observed that Raut had informed the insurer that the doctor had advised her to continue treatment till March 2011. Thus, "it cannot be said that there was delay in submitting the claim on the part of the complainant," the forum said.





`Insurer can't deny claim citing lack of post-mortem'





A consumer forum has held that the absence of a post-mortem report cannot be a ground for repudiation of an accidental death insurance claim in cases where the police are sure about the cause of death and there is no confusion.

On Wednesday , the forum directed New India Assurance to pay the widow of a 45-year-old man who died of snake bite in 2008 the insured amount of Rs 5 lakh, along with a compensation of Rs 1.05 lakh. Holding the company guilty of indulging in unfair trade practice, the forum said, "Depending upon the situation and circumstances and reports of the medical officer, the hospital as well as the police, the claim should have been sanctioned on humanitarian grounds. There is no proof to show that there was any mischief or mala fide intention of the complainant in demanding the claim."

The forum rejected the insurance company's defence that it was not in the domain of the police to conclude the cause of death and that the job was of medical doctors, and that despite the advice of doctors, the woman--Dombivli resi dent Usha Bhoir--had failed to allow the post-mortem.

"The police are also a government and responsible investigative authority . As they were sure about accidental death, they did not go for post-mortem. So, merely saying that a post-mortem was not done and hence claim is repudiated is unfair," the forum said.

The forum observed that Bhoir could not have insisted on a postmortem and the final authority in the matter was the police. It pointed out that the police had recorded the statements of witnesses, conducted a panchnama and finally on July 10, 2008, had submitted a summary report to the sub-divisional magistrate, stating that the death was accidental.

Bhoir's husband Ashok had taken membership of a luxury club in Prabhadevi in 2007. The club had a tie-up with the insurance company and as per rules insured its members. In her complaint to the Central Mumbai District Consumer Disputes Redressal Forum in 2012, Bhoir said that on June 22, 2008, at 3pm, her husband had gone into the cattle shed on their premises, where he was bitten by a snake hidden in the grass. Ashok was taken to hospital, where at 9.15pm he suffered cardiorespiratory failure due to poisoning and died.





Weak monsoon may hit recovery India Inc Fears ‘Below Normal’ Rains Will Affect Demand, Sentiment

New Delhi: With the economic growth hovering around 5% and the job scenario remaining weak, a "below normal" monsoon will be the first challenge awaiting the new government that will take charge just before the rainy season sets in. The already-stretched finances of the Centre will only add to the pressure. 

    While economists warned that below normal rains do not necessarily mean a drought or significantly hit the growth rate, Corporate India is already talking about the monsoon further denting the already-battered sentiment and impacting sales at a time when it was sensing a reversal in fortunes. 
    Private agencies had warned of the monsoon being below normal and, on Tuesday, the India Meteorological Department (IMD) forecast that rains will be below the average level. Coupled with that is the fear of the El Nino weather phenomenon impacting precipitation further. 
    Videocon Group chairman V N Dhoot said that a bad monsoon may impact demand, especially in rural areas that depend on the farm sector. "It's not good news at all. Even though the dependence on monsoon has gone down, it will affect sentiments and it will come at a time when we are a little optimistic about a turnaround," added Anil Dua, senior vice-president (marketing & sales), Hero MotoCorp, the country's largest two-wheeler maker. Rural areas account for 48% of the company's sales. 
    Pravin Shah, CEO of Mahindra & Mahindra's automotive business, said, "It doesn't have an immediate impact but it does impact sentiments." Hero's rival and former partner Honda isn't reworking its targets just yet, although Y S Guleria, the head of sales and marketing at HMSI, says that monsoon and economic growth are inseparable. 
    Economists are also not changing their forecasts just yet. "The government should be on alert, we should prepare ourselves to deal with the prospects of below normal rains but there is not need to panic," said Ashok Gulati, chair professor for agriculture at the Indian Council for Research on International Economic Relations (ICRIER). 
    There may, however, be some impact on inflation. While north-west India, which has better irrigation facilities, may not be affected significantly, Gulati said there may be some impact on the western region which grows oilseeds, cotton, sugarcane and onions. 
    With record food stocks, the government seems to be wellpositioned to deal with demand for grain. But a prolonged dry spell does impact milk production and may even hit prices of vegetables such as onions, which has been a political hot potato in recent years. 
    "It is early to assess the impact on growth, but it is a warning signal and there is a need to keep a watch on food inflation. It will be an important issue for the new government and it will have to take steps from day one," said A Prasanna, chief economist at ICICI Securities Primary Dealership. 
    But the impact on overall growth is not expected to be significant. "If the total rainfall is 95% of the average with even spread of space and time, then the impact will not be very significant on agriculture production," said D K Pant, chief economist and head (public finance) at India Ratings, while sticking to his forecast of 3% farm sector growth this year. 
    Dhoot cautioned that the government may have to increase spending in the rural areas to counter any negative fallout if the rainfall is highly deficient. Typically, in a raindeficient year, the government gets banks to restructure farm loans and spends more on job-generating schemes in areas where there is severe shortfall.

DARK CLOUDS OVER GROWTH?

Insurance firms now paying for bariatric surgery for diabetes

Mumbai: After years of looking at bariatric surgery as a cosmetic weight-loss procedure, Indian medical insurance companies seem to have changed their minds. They have begun reimbursing some patients who have undergone bariatric surgery — now classified as a metabolic operation that involves cutting or bypassing parts of the stomach and intestine — to control or even get rid of their diabetes. 

    K Satishan (name changed), a 62-year-old businessman from Pune who was a diabetic patient for 15 years, got Rs 5 lakh reimbursement from Bajaj Allianz after he and his doctors explained that the surgery was literally his last option. “I was on high doses of insulin and oral medication and yet my sugar levels were four times the normal one,” said Satishan. 
    While bariatric surgeries essentially lead to weight loss, a welcome side-effect has been the control of diabetes and hypertension. 
    These surgeries were initially recommended for morbidly obese people, but in the last five years, they are being offered to diabetic patients who are not obese. 
    “Satishan was weighing 90-odd kilos. His weight was not as much a problem as his diabetes and hypertension were,’’ said Dr Shashank Shah, the metabolic surgeon from Pune who operated on the businessman. 
OPERATION SUCCESSFUL 

• There are 60 million people with diabetes in India 

• Bariatric or metabolic surgery is considered appropriate treatment for people suffering from type 2 diabetes and obesity 

• The surgery involves cutting or bypassing a portion of the stomach 

• Doctors say it triggers hormonal changes, makes the intestine work harder and faster, leading to reduction of weight and blood sugar ‘Payout on case-to-case basis for op’ 
    Another of Shah’s patients, Somnath Holkar, got reimbursed from United IndiaInsurance after six months of explanations. “I underwent the operation seven months ago and got the reimbursement last month,” he said. 
    Satishan recalled how he took his blood sugar and pressure readings every day and showed the three-month chart to the insurance company. “I don’t take any diabetic pills now. The company even interviewed my doctor before agreeing,” he said. He was operated in May 2013 and got his reimbursement recently. 
    Incidentally, the Central Government Health Scheme (CGHS) in December declared that it would fund bariatric surgeries for current and former government employees. Dr Ramen Goel, a metabolic surgeon from Mumbai, said if CGHS can fund surgeries for its employees, insurance companies should take the cue. 
    Sanjay Datta from ICICI Lombard said medical insurance companies have begun reimbursing bariatric and metabolic surgeries on a case-tocase basis. Metabolic surgery for diabetes is still in the trial stage, with many medical associations admitting that longterm studies are needed before accepting surgery as a cure for diabetes. Hence, many patients who have undergone metabolic surgeries in the last five years have got reimbursements only after moving consumer courts. “Many of my patients moved the consumer courts to get insurance reimbursement,” said Goel. 
    Doctors hope insurance payoffs will become the trend, especially because India has over 60 million diabetes patients. Shah, who has operated on 800 patients for diabetes, said many of them are now approaching insurance companies. “A patient who is scheduled to undergo surgery in Fortis Hospital in Mulund is awaiting hisinsurance company’s decision,” he added. 
DOC’S ADVICE 
    The International Diabetic Federation (IDF) says surgery can be offered for people with a body mass index of 35 kg/m2 or more 
    Among Asians, especially Indians, BMI points may be reduced by 2.5 kg/m2 
    IDF says surgery should be considered as an alternative treatment option in patients with a BMI between 30 and 35 kg/m2 when diabetes cannot be adequately controlled by optimal medical regimen, especially in the presence of other major cardiovascular disease risk factors

'If insurance policy is unclear, benefit must go to consumer'

Chennai: If there is any ambiguity in the terms of an insurance policy, the benefit should go to the consumer, a consumer forum here has ruled, asking aninsurance company to pay the entire medical claim amount to a man who underwent a surgery. 

    Manicklal Rathi, 69, took a mediclaim policy from National Insurance Company Ltd at an annual premium of Rs 28,000 under which he was covered up to a medical expenditure of Rs 4 lakh. Rathi, who had a policy for Rs 2 lakh since 2000, enhanced the cover to Rs 4 lakh in February 2010. Two months later, he underwent a knee replacement surgery, incurring an expenditure of Rs 2.69 lakh. 
    However, the company did not settle the full amount and withheld Rs 79,131. The company did not respond to his representations, prompting him to approach the Consumer Protection Council, Tamil Nadu, which filed a complaint on his behalf at the district consumer disputes redressal forum, Chennai (North). 
    In its reply, the company said that according to the terms of the policy, it could not reimburse the entire amount during the initial four years of the policy period. Further, it argued, Rathi had “already submitted a discharge voucher” for the sum he received and hence cannot stake claim for more. 
    Quashing the company’s arguments as “unsustainable” recently, the bench comprising president R Mohandoss and member T Kalaiyarasi found it guilty of negligence and deficiency in services. It directed the company to reimburse Rs 79,131 along with an interest of 9%. The forum also slapped a fine of Rs 5,000 on the company for deficiency in services and awarded Rathi another Rs 2,000 as case costs.

Insurance firms now paying for bariatric surgery for diabetes

Mumbai: After years of looking at bariatric surgery as a cosmetic weight-loss procedure, Indian medical insurance companies seem to have changed their minds. They have begun reimbursing some patients who have undergone bariatric surgery — now classified as a metabolic operation that involves cutting or bypassing parts of the stomach and intestine — to control or even get rid of their diabetes.      K Satishan (name changed), a 62-year-old businessman from Pune who was a diabetic patient for 15 years, got Rs 5 lakh reimbursement from Bajaj Allianz after he and his doctors explained that the surgery was literally his last option. “I was on high doses of insulin and oral medication and yet my sugar levels were four times the normal one,” said Satishan.      While bariatric surgeries essentially lead to weight loss, a welcome side-effect has been the control of diabetes and hypertension.      These surgeries were initially recommended for morbidly obese people, but in the last five years, they are being offered to diabetic patients who are not obese.      “Satishan was weighing 90-odd kilos. His weight was not as much a problem as his diabetes and hypertension were,’’ said Dr Shashank Shah, the metabolic surgeon from Pune who operated on the businessman.  OPERATION SUCCESSFUL  • There are 60 million people with diabetes in India  • Bariatric or metabolic surgery is considered appropriate treatment for people suffering from type 2 diabetes and obesity  • The surgery involves cutting or bypassing a portion of the stomach  • Doctors say it triggers hormonal changes, makes the intestine work harder and faster, leading to reduction of weight and blood sugar ‘Payout on case-to-case basis for op’      Another of Shah’s patients, Somnath Holkar, got reimbursed from United IndiaInsurance after six months of explanations. “I underwent the operation seven months ago and got the reimbursement last month,” he said.      Satishan recalled how he took his blood sugar and pressure readings every day and showed the three-month chart to the insurance company. “I don’t take any diabetic pills now. The company even interviewed my doctor before agreeing,” he said. He was operated in May 2013 and got his reimbursement recently.      Incidentally, the Central Government Health Scheme (CGHS) in December declared that it would fund bariatric surgeries for current and former government employees. Dr Ramen Goel, a metabolic surgeon from Mumbai, said if CGHS can fund surgeries for its employees, insurance companies should take the cue.      Sanjay Datta from ICICI Lombard said medical insurance companies have begun reimbursing bariatric and metabolic surgeries on a case-tocase basis. Metabolic surgery for diabetes is still in the trial stage, with many medical associations admitting that longterm studies are needed before accepting surgery as a cure for diabetes. Hence, many patients who have undergone metabolic surgeries in the last five years have got reimbursements only after moving consumer courts. “Many of my patients moved the consumer courts to get insurance reimbursement,” said Goel.      Doctors hope insurance payoffs will become the trend, especially because India has over 60 million diabetes patients. Shah, who has operated on 800 patients for diabetes, said many of them are now approaching insurance companies. “A patient who is scheduled to undergo surgery in Fortis Hospital in Mulund is awaiting hisinsurance company’s decision,” he added.  DOC’S ADVICE      The International Diabetic Federation (IDF) says surgery can be offered for people with a body mass index of 35 kg/m2 or more      Among Asians, especially Indians, BMI points may be reduced by 2.5 kg/m2      IDF says surgery should be considered as an alternative treatment option in patients with a BMI between 30 and 35 kg/m2 when diabetes cannot be adequately controlled by optimal medical regimen, especially in the presence of other major cardiovascular disease risk factors

Buying a back-dated insurance policy? While it's legal to purchase an insurance policy with a back date, remember that it may not always be beneficial for the buyer

Wouldn’t it be great if you could turn the clock back? You could make a lot of money by investing in the right stocks. While you can’t go back in time when it comes to stock investments, you can buy certain lifeinsurance policies with a back date. Back-dating of a life insurance policy is a perfectly legal and standard practice in the insurance industry. So, the new plans launched by insurance companies in the past 1-2 months can be bought with any date in the financial year starting 1 April 2013.  Is back-dating useful?  Back-dating is useful in certain situations. A life insurance policy is not the best way to save tax and there are better, more flexible and lucrative options to do so. Even so, millions of taxpayers buy life insurance to save tax. If a taxpayer needs to exhaust his Section 80C limit through a life insurance policy this year but wants to pay the premium on a monthly or quarterly basis from next year, he will find back-dating useful. He can pay the premiums for this year at one go, and from next year, he can pay them whenever they are due.      It is also useful in case the buyer has just crossed the minimum age for buying a certain policy.      There are also sentimental reasons for back-dating. Sometimes, buyers want their insurance policies to be issued on an important date during the year. It could be a birthday, wedding anniversary or any other date with emotional value. This also ensures that the maturity of the policy coincides with that important date. It also sets a reminder for the premium.  Look before you leap  Going back in time also reduces the waiting period for the policyholder. If you buy a money-back policy in March 2014, you will get the first tranche (which is 20% of the sum assured) after five years in 2019. However, if you back-date the policy to April 2013, you will get the money in four years and one month, in April 2018.      Before you are led into believing that this is a great way to get your money back faster, do the math. The next premium becomes due in a month in April 2014. Also, you are charged a 10% interest on the premium you pay for the back-dated policy. “It makes little sense to pay 10% interest on a policy that earns you only 6-7%,” says a Delhi-based insurance expert.      If the back date is more than one month away, the buyer is charged a 10% annual interest on a pro-rata basis. So, if you want to back-date a policy by three months, be ready to pay an interest of 2.5%. The Anand Money Back package, a combo of two money-back plans and an endowment policy, being hawked by LIC agents, has one plan dating back to April 2013. The premium will be due next month.      Incidentally, the interest on the back-dating kicks in only after 30 September. Till this cut-off date, the LIC does not charge any interest even if the policy is back-dated by 5-6 months. There is also no charge if the back-dating is for less than a month.  Zero sum game  Insurance agents use back-dating to lure buyers. Insurance companies base their premiums on the policyholder’s age. LIC, for instance, goes by the last birthday of the buyer. If the policy dates back to before your birthday, the premium will be lower. However, this is a zero sum game. In your quest for a lower premium rate, you will end up paying extra premium. This is why back-dating works only in endowment and money-back plans. Back-dating a term plan is an exercise in futility because the coverage for the entire back-dated period effectively goes waste.

Brutal Arctic blast leaves 187m shivering in US At -16°C, NY Breaks 118-Yr-Old Record Of Lowest Temperature

New York: A deadly blast of arctic air that shattered decades-old records as it gripped the middle US moved eastward on Tuesday, cancelling thousands of flights, paralysing road travel and closing schools and businesses. 

    Forecasters said some 187 million people could feel the effects of the "polar vortex" by the time it spreads across the US. New York's Central Park 
hit a record low temperature for the day of -16°C, shattering a 118-year-old record, but with winds gusting to 51kmph conditions felt far colder, according to the US National Weather Service. The cold broke records in Chicago, which set a local record on Monday at minus -27°C, and elsewhere. 
    Shelters for the homeless were overflowing due to the severe cold brought by a polar air mass that produced the coldest temperatures in two decades and at least four deaths. 
    Temperatures were expected to be 14°-19° celsius below normal from the midwest to the southeast, the National Weather Service warned. 
    After running into unpassable snow and ice, three Chicago-bound Amtrak trains came to a halt on Monday afternoon, stranding more than 500 passengers overnight. They had heat, water, lights and toilet facilities, according to Amtrak. As of Tuesday morning, passengers on two trains, which spent the night on the tracks in Bureau County, Illinois were being transported to Chicago by chartered bus, an Amtrak spokesman said. More than 15,000 customers in Indiana remained without power. 
    In the normally mild south, Atlanta recorded its coldest weather on this date in 44 years, when the temperature dropped to -14°C. Wholesale electricity prices in the central and eastern US spiked far above their normal seasonal level as homes and businesses needed to use more energy to warm buildings. 
    The deep freeze snarled many Americans' morning commutes with icy or closed roads and flight delays on Tuesday, with some 1,987 US flights cancelled and roughly 1,028 delayed, according to FlightAware.com. Major US cities from the midwest to the east coast were in the grip of temperatures below freezing, with Chicago at -23°C, Detroit -24°C, New York -14°C, Washington -13°C and Boston -11°C. AGENCIES 
Oil prices shoot up 
    The price of oil rose to near $94 a barrel on Tuesday as unusually cold weather in the US was expected to fuel demand for energy. By mid- afternoon in Europe, benchmark US oil for February delivery was up 42 cents to $93.85 a barrel in electronic trading on the New York Mercantile Exchange. On Monday, the contract fell 53 cents to settle at $93.43 a barrel. AP

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