Date of filing:- 12/10/2020. Date of Order/Judgement:-24/07/2023.
DISTRICT CONSUMER DISPUTE REDRESSAL COMMISSION,
B A R G A R H.
Consumer Complaint No. 76 of 2020.
Surya Kumar Barai, aged about 50 years, S/o. Late Rahasa Bihari Barai, R/o. & P.O. Katapali, Via. Bardol 768038, Ps/Tahasil/Dist. Bargarh (Odisha).
Complainant.
V e r s u s
- The Branch Manager, ICICI Lombard General Insurance Company Ltd, Ground Floor Nisha Building, In front of SBI Personal Branch, Bandutikra Chowk, Ward No. 9, Bargarh, Po/Ps/Dist. Bargarh 768028.
- The Branch Manager, ICICI Lombard Health Care ICICI Bank Tower, Plot No. 12, Financial District Nankaramguda Gachibowli, Hyderabat 500032.
- The General Manager, ICICI Lombard Insurance Company Ltd, ICICI Lombard House, 414, Veer Savarkar Marg Near Siddhi Vinayak Temple, Prabhadevi Mandir, Mumbai, Pin. 400025.
Opposite Parties.
Counsel for the Parties:-
For the Complainant :- :- Sri M.K. Satpathy with Associates.
For the Opposite Party No.1 :- :-
For the Opposite party No.2 and 3:- :- Sri Ashok Kumar Dash (A), Advocate.
-: P R E S E N T :-
Smt. Jigeesha Mishra ..... ..... ..... ..... ..... P r e s i d e n t.
Smt. Anju Agarwal ..... ..... ..... ..... ..... M e m b e r (W).
Dt.24/07/2023. -: J U D G E M E N T:-
Presented by Smt. Jigeesha Mishra, President :-
- The Case of the Complainant is that the Complainant is a bonafide policy holder of ICICI Lombard Health Insurance vide policy No. 4065/CCSM/02591270/00/000. He raised the said policy for his personal and family health and critical case purpose on payment of requisite premium. The wife of the Complainant Saraswati Barai suddenly suffered heart problem and become serious and ultimately died on 12/12/2015. The Complainant placed the insurance claim before the Opposite Parties. The Complainant has also furnished relevant documents as desired by the Opposite Parties. But the Opposite parties did not settle the claim of the Complainant. Hence the Complainant filed this case before this Commission.
- The Case of the Opposite parties is that the Opposite Parties filed its version and submitted that the case is not maintainable on the point of limitation. Further the Opposite Parties submitted that the Complainant has concealed the fact that the insured was undergoing treatment of Hypertension since 10 years, which falls prior to policy start date. The crucial post medical history was not disclosed at the time of proposing for the present policy. So as the claim is not admissible the said fact is intimated through repudiation letter Dt. 8th July 2016 to the Complainant. Hence there is no deficiency on the part of the Opposite Parties.
- Perused the Complaint petition, version and documents filed by both the parties and following issues are framed:-
ISSUES
- Whether the Complainant is barred by limitation?
- Whether the Opposite Parties are deficient in its service ?
- What relief the Complainant is entitled to get ?
Issue No.1:-
The Opposite Parties submitted that the cause of action arose on dated 08/07/2016, the date of knowledge of rejection of his insurance claim, whereas this Consumer case has filed in the year 2020. Hence the case is not maintainable on the point of limitation. Perused the record and it reveals that although the repudiation was made on 08/07/2016 the advocate of the Complainant sent an advocate notice on 21/08/2020. When the Opposite Party did not respond, the Complainant filed this case on 12/10/2020. Hence the case is not barred by limitation and the case is maintainable.
The issue is answered accordingly.
Issue No.2:-
Perused the documents filed by the parties and it reveals that the policy No. 4065/CCSM/0259/270/00/000 was issued by the insurance company ICICI Lombard and the insured is Saraswati Barai and nominee is Surya Kumar Barai. The policy was valid from 25 March 2013 to 24 March 2016. The relationship between the Complainant and insured is spouse. The wife of the Complainant died on 12/12/2015. The Complainant filed the death certificate of his wife Saraswati Barai. It is also reveals from the document that Rs. 5,521/-(Rupees five thousand five hundred twenty one)only was paid as premium of the insurance policy and the sum insured is Rs. 6,00,000/-(Rupees six lakh)only. The Opposite party submitted that the insured did not disclose about pre existing disease. It is also submitted that the insured was suffering form hypertension since 10 years. In order to escape from liability the Opposite Party is taking plea. It is the duty of the Opposite Party to conduct medical check up during the time of giving policy. Hence the plea taken by the Opposites is not acceptable. The Opposite Parties are deficient in their sevice for non settlement of claim of the Complainant.
Accordingly the issue is answered.
Issue No.3:-
For deficiency in service of the Opposite Parties the Complainant is entitled to get relief. The issue is answered accordingly.
As per supra discussion the following order is passed.
O R D E R
The Complaint is allowed on contest. The Opposite Parties are directed to pay Rs. 6,00,000/-(Rupees six lakh)only to the Complainant within 30 days of this Order. Further the Opposite Parties are directed to pay Rs. 30,000/-(Rupees thirty thousand)only compensation for harassment and mental agony and Rs. 10,000/-(Rupees ten thousand)only for litigation expenses to the Complainant. Failing which the entire amount will carry 12% interest P.A. till realization.
Order pronounced in the open court on 24th day of July 2023.
Supply free copies to the parties.
Typed to my dictation
and corrected by me.
I agree/-
( Smt. Anju Agrawal) (Jigeesha Mishra)
Dt.24/07/2023 Dt.24/07/2023
M e m b e r (w) P r e s i d e n t
