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Case Review: Insurance
Summary of some of the decisions made by the Mediators on some of the complaints received by FMB.
This summary is for information only and should not be used for other purpose.
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IMB/1834/L Temporary Disability Benefit
The assured had an accident on 15.1.2004. He consulted the doctor on 16.1.2004 whereby an x-ray of the injured foot was taken. It was reported that the assured had a " minimally displaced left calcaneum fracture ". The attending doctor reported that based on the x-ray, the assured sustained fractured left calcaneum and was unable to stand, walk, climb ladders without use of crutches. The doctor certified the assured as totally disabled from 16.1.2004 to 11.5.2004 ( 117 days ) and partially disabled from 12.5.2004 to 11.7.2004 ( 61 days ).
The insurers offered to pay only 14 days Temporary Total Disability and 7 days Temporary Partial Disability based on an x-ray taken more than 4 months after the accident ( which showed no fracture ) and their doctor's advice.
The Mediator was not satisfied with the basis of the insurers' offer. Upon being queried the insurers revised their offer and settled the claim based on the recommendation of the attending doctor.
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