Consumer injured in joyride, insurance company asked to give over Rs 7 lakh payout

Hiren Joshi had taken a Happy Family Floater Policy of Rs 6 lakh from Oriental Insurance which covered him, his wife and his dependant parents. The policy included personal accident coverage.
Hiren got married and went on a honeymoon to Manali on a trip organized by Heena Tours and Travels. One of the attractions was paragliding. The paragliding activities were operated by trained persons.Hiren’s parachute, however, developed a technical snag, and the pilot could not control it, leading to a crash on a rocky hill. Hiren sustained grievous injuries in the accident which occurred on December 10, 2014.
He was hospitalized till January 6, 2015 after which he returned to Mumbai for further hospitalization and treatment which continued till April 4, 2015. As the accident had occurred during subsistence of the policy-- valid from November 20, 2014 to November 19, 2015-- he filed a claim under the policy.
The insurer rejected the claim on the ground that paragliding was a risky activity, and that the policy did not cover accidents occurring during aviation or ballooning except as a bonafide passenger.
Since Hiren was paragliding, the insurer termed it a hazardous activity which was excluded under the policy. Hiren approached the insurance ombudsman who upheld the insurer’s stand, so he filed a consumer complaint.
Advocate Ami Mandani who represented Hiren, argued the exclusion clause was not applicable since Hiren was not operating the parachute while paragliding, but was merely enjoying a joy ride
which was being operated by a trained pilot. Even a tour operator had endorsed this fact, but the insurer argued the tour operator was not entitled to opine. It defended the repudiation under clause 4.19 of the policy.
The forum observed the policy was in existence since several years during which period no claim had been made. It concurred with advocate Ami Mandani that the exclusion clause would not apply to joy rides under trained pilots. The forum also noted that clause 4.19 of the policy had no bearing on the dispute.
Accordingly, by its order of June 1, 2019 delivered by M P Kashar for the bench headed by Sneha Mhatre and D S Paradkar, the forum concluded the claim had been wrongly repudiated which constituted a deficiency in service.
It noted even though the expenses for treatment had exceeded the coverage limit, Hiren had restricted his claim to the benefits available under the policy. The forum ordered Oriental Insurance to pay Rs 6 lakh for medical expenses and Rs 1,28,125 as personal accident benefit.
Both these amounts would carry 3% interest from the date of the complaint being filed. In addition, Rs7,000 was awarded as compensation for mental agony and Rs 3,000 as litigation costs. The insurer has been given two months to comply with the order.
(The author is a consumer activist and has won the Govt. of India’s National Youth Award for Consumer Protection. His email is jehangir.gai.columnist@outlook.in)