#Mediclaim

The Delhi State CDRC awarded compensation, holding the insurer liable under Mediclaim policy clause 4.2 for failing to prove exclusion despite continuous coverage, and reinforced that insurers must substantiate exclusions to protect policyholders.

The Calcutta High Court held that a deliberately caused act can still qualify as an ‘accident’ under Section 166 of the Motor Vehicles Act, raising the award to Rs 60 lakh with 6 % interest and rejecting the insurer’s Mediclaim set-off claim.