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‘Limb Rendered Useless In US Cannot Get Functional In India’

| Updated: July 7, 2024 14:28

The National Consumer Dispute Redressal Commission ruled in favour of an NRI, ordering an insurance company to pay her full claim with 7% interest for the past 18 years. 

The incident relates to one Sonali Shah, who broke her hand while working at a food outlet in New Jersey, US, and embarked on a long legal battle to receive her rightful compensation. Shah had purchased two Mediclaim policies from National Insurance Co Ltd.

On July 7, 2003, while working in a Burger King outlet, she fell and broke her left hand. She lodged a claim in the US and was paid $60,000 under the US workers’ compensation law. Her disability was considered 100%. She was unable to use her left arm and awarded monthly compensation of $90 for 37 years.

Back in India, Shah’s insurance policy covered Rs 5 lakh for 100% disability and a weekly compensation of Rs 5,000 for up to 104 weeks. She filed a claim for 100% disability and sought compensation for 96 weeks. She submitted medical documentation and certifications from US doctors, and even offered to travel to India for a physical examination. 

However, the insurance company assessed her disability at a mere 15% on the basis of documents sent by her and offered her a paltry Rs 25,000.

Shah dragged the insurer to the Consumer Dispute Redressal Forum, Ahmedabad, which in 2010 ordered the company to pay her Rs 9.38 lakh with interest.

However, the Gujarat State Consumer Dispute Redressal Commission reversed the order by saying that the decision of US adjudicating authority was not binding on Indian courts, and the disputed landed in the national commission.

NCDRC concluded that the state commission committed an error in holding that foreign judgement is not binding on Indian courts and observed that it ought to have considered that the factum of disability of the consumer’s limb remains the same whether it is in the US or any other country.

“The limb which is rendered useless in the US cannot get functional in India,” it observed and added that there was no reason for the insurer not to believe the conclusion of the US medical authority.

On the insurer relying on its own doctor’s opinion on the extent of disability, NCDRC said, “The state commission ought to have considered that in case of conflict of opinion of two doctors, the opinion of the doctor who actually physically examined the injured must be preferred.”

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