Haryana

StateCommission

A/338/2014

New India Assurance Company Ltd - Complainant(s)

Versus

Ajay Jaiswal - Opp.Party(s)

B S Tanque

16 Dec 2016

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

HARYANA PANCHKULA

 

 

First Appeal No.338 of 2014

Date of the Institution:29.04.2014

Date of Decision:16.12.2016

 

1.      New India Assurance Company Ltd., Regional Office, SCO No.36-37, Sector-17-A, Chandigarh.

2.      New India Assurance Company Ltd., through its Branch Manager, 6269 Nicholson Road, Ambala Cantt.

                                                                             .….Appellants

Versus

Ajay Jaiswal son of Shri Prem Chand Jaiswal, resident of 120-149 Bihari Lal Building, Railway Road, Ambala Cantt.

                                                                             .….Respondent

CORAM:    Mr.R.K.Bishnoi, Judicial Member

                    Mrs. Urvashi Agnihotri, Member

 

Present:-    Mr.B.S. Tanque, Advocate counsel for the appellants.

                    Mr.Ajay Chikkara, Advocate counsel for the respondent.

 

O R D E R

URVASHI AGNIHOTRI, MEMBER:

 

1.     New India Assurance Company Ltd. and Anr. -OPs are in appeal against the Order dated 20.03.2014, passed by the learned District Consumer Disputes Redressal Forum, Ambala (for short ‘District Forum’), whereby the complaint of Ajay Jaiswal, complainant has been allowed by directing the OPs to pay Rs.2,25,254/- alongwith interest @9%p.a. with Rs.15,000/- as compensation for harassment and mental agony and Rs.5,000/- as litigation expenses.

2.      Briefly stated, according to the complainant, he got himself insured alongwith his wife Smt. Krishna Rani under the Hospitalization & Domiciliary Hospitalization Benefit Policy vide Policy No.353501/48/06/20/70000253 for the period 31.07.2006 to 30.07.2007 by paying a premium of Rs.9,066/-+Rs.1110/- service tax totaling Rs.10,176/-. This was further renewed for the period from 31.07.2007 to 30.07.2008 by paying a premium of Rs.10,182/- including service tax vide Cheque No.854514 dated 27.07.2007. The complainant got himself checked up from Silver Oaks Cardiac Care Centre, SAS Nagar, Mohali and was admitted there on 13.11.2007 and was discharged on 15.11.2007 where he was diagnosed and checked by Doctors of the Silver Oaks hospital. Thereafter, the complainant got himself examined on 30.11.2007 in Max Devki Heart and Vescular Institute, Saket, New Delhi, where he was operated upon on 03.12.2007 by Dr. Anil Bhan and Dr. Sharda. He remained admitted there as indoor patient and was discharged on 10.12.2007. The complainant spent a sum of Rs.17054/- in Silver Oak Hospital, Mohali vide receipt No.R0026778 dated 15.11.2007 and spent a sum of Rs.2,01,252.29 in Max Devki Hospital, New Delhi and on various dates as detailed in the bill by spending a sum of Rs.6947.50 on follow up treatment. The complainant submitted the mediclaim to the OP, but the same was rejected by them alleging suppression of material facts regarding pre-existing disease. Aggrieved against this, the complainant approached the District Forum claiming Rs.2,25,254.28 alongwith interest as compensation and litigation expenses.

3.      Contesting the complaint, the OPs pleaded that the complainant had procured the aforesaid insurance policies by concealing and suppressing the material facts about his pre-existing ailment i.e. DM II with hypertension and Angina Class with TVD for the last 20 years. Therefore, the complainant had intentionally concealed and suppressed the material facts about pre-existing ailment to derive illegal benefits of policy from the OP. Hence, the claim was rightly and legally held not maintainable and payment under Clause 4.1 of standard mediclaim policy. Thus there was no deficiency in service on their part and the OP prayed for the dismissal of the complaint. However, the learned District Forum rejected the pleas raised by the OPs and accepted the complaint vide order dated 20.03.2014 by granting the aforesaid relief. 

4.      Against the impugned order, the OP/appellant has filed appeal before us reiterating the same pleas as raised before the District Forum. We have heard the learned counsel for the parties and have also gone through the record. From a perusal of the record it is evident that the complainant did get himself insured with the OP by paying the requisite premium. He also got the same renewed in time and it was during the currency of the policy that he got himself admitted first in Silver Oaks Hopital, Mohali and thereafter in Max Daveki Hospital, Delhi. The doctors after proper diagnosis treated him by administering the various medicines in their prescriptions as well as in the discharge summary. It was, however, inadvertently and by typographically mistake recorded by Dr. Arvind Kaul that the claimant was suffering of hypertension and diabetes “for the last 20 years” instead of “02 months”.   This clerical mistake was rectified by Dr. Kaul lateron, but the OPs have unnecessarily made an argument out of that. Otherwise there is no evidence whatsoever regarding the allegation of the claimant suffering from any pre-existing disease, much less from the last 20 years.

5.      Consequently, we do not find any merit in the appeal and entirely agree with the well reasoned decision of the learned District Forum and the appeal is accordingly dismissed with no order as to costs.

 

7.      The statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the appellant against proper receipt and identification in accordance with rules.

December 16th, 2016

Mrs.Urvashi Agnihotri, Member, Addl.Bench

R.K.Bishnoi, Judicial Member Addl.Bench

 

R.K.