Date of filing:- 28/11/2022.                                                                                Date of Order:-28/08/2023.

DISTRICT CONSUMER DISPUTE REDRESSAL COMMISSION,

B A R G A R H.

Consumer Complaint No.   23  of 2022.

Ashutosh Dash, son of  Purna Chandra Dash, aged about 29 years, R.o. Khajurtikira, W.No.8, Bargarh, Po/Ps/Dist. Bargarh.

                                                                                                                                                                   Complainant.

                                            V e r s u s

1. The Manager, Star Health and Allied Insurance Company Ltd, At. 2nd Floor Quality Mansion, Nayapara, Sambalpur, Po/Ps/Dist. Sambalpur.
2. The Manager, Corporate Office, Star Health and Allied insurance Company Ltd,New Tank Street, Valluvar, High Road, Nungambakkam, Chennai 600034,Tamil Nadu.
3. The Zonal manager, Star Health and Allied Insurance Company Ltd, 2nd Floor,      Plot No. 23C, Behind Hotel Royal Mid Town, Ashok Nagar, Janpath Bhubaneswar 751009.            

                                                                                                                                              Opposite Parties.                         

Counsel for the Parties:-

For the Complainant :-          :- Sri S.N. Padhi, Advocate with Associates.

For the Opposite Parties :-    :- Ashok Kumar Dash, 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.28/08/2023.                                 -: J   U  D   G  E  M  E  N  T:-

Presented by Smt. Jigeesha Mishra, President :-

1. The Case of the Complainant is that the  Father of the Complainant proposed for health insurance of his wife Kanaklata Dash @ Kanaka Dash who is the Mother of the Complainant. On 25/07/2021 the Father of the Complainant paid Rs. 22,066/-(Rupees twenty two thousand sixty six)only through cheque as advance premium receipt towards health insurance of Kanaka Dash. After payment of the premium the Opposite Party No.1 issued Comprehensive  insurance policy bearing No. P/191214/2021/001475 in favour of Kanaka Dash valid from 25/07/2020 to 24/07/2021 wherein the Complainant is cited as nominee. During the validity period of the policy on 06/04/2021 at about 12:30 PM the insured Kanaka Lata Dash while worshipping, accidentally her wearing clothes came in contact with the burning Earthern Lamps, as a result she sustained burn injury on her person. Thereafter she was taken to nearby Dr. P.L. Tripathy for preliminary treatment as an outdoor patient. After two days of his treatment doctor advised to shift her to I.G.H. Rourkela. Accordingly, she was admitted in I.G.H, Rourkela on 09/04/2021 as an  indoor patient. During her treatment she died on 15/04/2021. On 26/09/2021 the Complainant filed claim application before the Opposite Party No.1 through Regd. Post and the Complaint is registered as C.I.R/2022/19/1214/02/3398393. The Opposite Party No.1 sent letter dated 22/12/2021, 31/01/2022 and 16/04/2022 for different documents. The Complainant submitted all the required document as asked by Opposite Party No.1. Instead of settling the claim, the Opposite party again and again asked the Complainant to submit different documents. The Opposite Parties have not provided proper service to the Complainant and the conduct of the Opposite Parties are coming under the purview of unfair trade practice and deficiency in service. Hence the Complainant filed this case before this Commission.
2. The Case of the Opposite Parties is that the Opposite Parties No.1 to 3 Star Health and Allied Insurance Company Limited filed their version. The Opposite Parties submitted that  as per certificate of Dr. P.L. Tripathy the patient suffered 40/45 % burn injuries on 06/04/2021. She was initially under his care till 09/04/2021, after which she was hospitalized in Ispat General Hospital. These actions were suspicious, as hospitalization should have been done immediately. Further the Opposite parties submitted that the insured was a Type 2 Diabetes Mellitus, Hypertension, Chronic Kidney disease and coronary Artery Disease with a history of Coronary Artery Bypass Graft. The Proposer/insured has intentionally hidden the material facts with the Opposite Parties. Hence the Opposite Party repudiated the claim vide letter dated 31/05/2022. The Opposite parties are not deficient in service and prayed for dismissal of the case.
3. Perused the Complaint petition, version and documents filed by the parties and following issues are framed:-
4.  

1.Whether the Opposite Parties are  deficient in their service ?

2. What relief the Complainant is entitled to get ?

Issue No.1.

            It is the admitted fact that Kanaka Dash is the insured in the Policy bearing No. P/191214/01/2021/001475. The Complainant Asuthosh Dash is the nominee as per the insurance policy. The policy was valid from 25/07/2020 to 24/07/2021. During the currency of the policy the insured died on 15/04/2021. The Complainant lodged claim vide claim No. CIR/2022/191214/02/3398393 sent documents i.e. death certificate P.M. report, Adhar card, Bank account copy on 29/06/2021 through regd. Post. But the Opposite Party rejected the claim on the ground that the proposer/insured has not disclosed the pre existing disease. It is clear from the policy that the insured/proposer has disclosed the pre existing disease about diabetes, hypertension and cardiovascular diseases. Hence the rejection of the claim made by the Opposite parties is improper. When the policy is valid and the death occurred during the currency of the policy, it was the duty of the Opposite parties to settle the claim. But the Opposite parties rejected the claim and did not settle the claim Non settlement and rejection of claim of the Complainant amounts to deficiency in service on the part of the Opposite Parties.

            The Complainant filed amendment petition and submitted that the Opposite Party used defamatory word in the version. Perused the version and it reveals that the Opposite Party used the word  black mail in the version. Defamatory statement is one which tends to injure the reputation of the plaintiff. Defamation is of two types (1) Slander (2) Libel. Slander is the publication of a defamatory statement in transient form i.e. by words or gesture. Libel is representation made in some permanent form e.g. writing, Printing, Picture, effigy or statute. Here the Opposite Party used the defamatory word in writing form which comes under libel. Reputation of a person is most valuable property and it is more valuable than other property. The Opposite Party used this type of word to defame the Complainant. Hence the Opposite Party is warned not to use this type of defamatory word again in future.

As per the above discussion the Opposite Parties are deficient in service. The issue is answered accordingly.

Issue No.2.

            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 against the Opposite Parties. The Opposite Parties are directed to pay Rs. 5,00,000/-(Rupees five lakh)only to the Complainant within 30 Days of this Order. Further the Opposite parties are directed to pay Rs. 5,00,000/-(Rupees five lakh)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 open court on this  28^th   day of  August 2023.

            Supply free copies to the parties. 

      Typed to my dictation

                                                                                          and corrected by me.                                                                                           

                   I  agree/-                                                                       

       ( Smt. Anju Agrawal )                                                                  ( Jigeesha Mishra )

              Dt.28/08/2023                                                                            Dt.28/08/2023

              M e m b e r  (w)                                                                        P r e s i d e n t.