Haryana

Gurgaon

CC/367/2012

ShishPal - Complainant(s)

Versus

Appollo Munich Ins etc. - Opp.Party(s)

18 May 2016

ORDER

                     DISTRICT   CONSUMER   DISPUTES   REDRESSAL FORUM,GURGAON-122001

                                                                                     Consumer Complaint No: 367 of 2012                                                                                                                           Date of Institution: 19.09.2012/04.10.2012                                                                                                                             Date of Decision: 18.05.2016

Sheeshpal H.No.2028, Sector 24, Aadarsh Nagar, Ballabgarh, Faridabad.                                                                                                                                                                                                                                        ……Complainant.

                                                Versus

M/s Apollo Munich Health Insurance Company Ltd, 10th Floor, Tower-B, Building No.10, DLF Cyber City, DLF City, Phase-II, Gurgaon through its Manager.

 

Puneet Mutreja H.No.65/A, Single Story, near Sona Bakers, Ramesh Nagar, New Delhi-110015.

 

..Opposite parties

                                                                                               

Complaint under Sections 12 & 14 of Consumer Protection Act,1986                                                                  

 

BEFORE:     SHRI SUBHASH GOYAL, PRESIDENT

SMT JYOTI SIWACH, MEMBER

                   SH.SURENDER SINGH BALYAN, MEMBER.

 

Present:        Complainant in person

                    Shri Shakunt Saumitra, Adv for OP-1

                    OP-2 exparte.

 

ORDER        SUBHASH GOYAL, PRESIDENT.

The case of the complainant, in brief, is that he was holding Mediclaim policy bearing No.361101/48/10/8500004219 of National Insurance Company which was valid from 25.10.2010 to 24.10.2011. The agent of OP-1 i.e. OP-2 approached the complainant and showed notification issued by Government of India by which a policy holder can change the service provider without any break and with full benefits of previous policy. Thus, being lured by OP-2, the complainant had taken policy from OP-1 bearing No.110106/11050/1000249817 against the premium of Rs.20,615/-. However, the complainant received a fresh mediclaim policy showing the effective date of policy as 23.10.2011 to 22.10.2012 though it should have been issued w.e.f. 25.10.2011 to 24.10.2012.  The complainant requested the OPs to correct the date in the insurance policy but of no use. Thus, he sought cancellation of the policy and refund of the premium amount of Rs.20, 615/- with interest. He also claimed compensation of Rs.50,000/- for harassment and mental agony and litigation expenses to the tune of Rs.11000/-.

2                 OP-1 in it written reply has alleged that the complainant has not come to the Forum  with clean hands and suppressed the material facts as he has raised a claim for Rs.16,828/- in the policy for the treatment of PIVD with Type II uncontrolled Diabetes which was also settled by OP-1 for Rs.15,478/- and therefore now after reaping the benefits under the policy the complainant is barred from seeking cancellation of the policy and refund of the premium and as such the present complaint is not maintainable.

3                 OP-2 failed to turn up despite service and thus, was proceeded exparte vide order dated 25.10.2013.

4                 We have heard the parties and have perused the record available on file.

5                 Therefore, from the facts and circumstances of the case, evidence on the file and the arguments advanced by the parties, it emerges that the complainant has filed the present complaint against the OPs alleging deficiency in service on their part on the ground that he was holding Mediclaim policy bearing No.361101/48/10/8500004219 of National Insurance Company which was valid from 25.10.2010 to 24.10.2011 and later on as per the scheme of the government had obtained the policy in question from OP-1 but they have issued the policy by showing wrong date and he requested for the correction but of no use and thus, he sought cancellation of the policy and refund thereof.

6                 However, as per the contention of the OP-1, there was no deficiency in service on the part of the OP as the complainant has not come to the Forum with clean hands and he has not disclosed the true fact because he has raised a bill of Rs.16,828/- in the policy for treatment of PIVD with Type II uncontrolled Diabetes which was also settled by OP-1 for Rs.15,478/- and thus, he has taken the benefits from the insurance policy and thus,  he cannot seek the cancellation of the policy.

7                 However, after going through the facts and circumstances of the case and the evidence placed no file it emerges that the complainant has sought refund of the premium amount of Rs.20617/-along with interest which was paid by the complainant as premium for the purchase of mediclaim policy w.e.f.23.10.2011 to 22.10.2012. However, the present complaint has been filed on 06.09.2012 i.e. just on the verge of expiry of the said policy which has expired on 22.10.2012. Therefore, the said policy had remained in force for approximately one year and as such no ground for refund of the premium amount is made out. It is also pertinent to mention here that  the complainant has also raised the claim of Rs.16,828/- which was settled by the OP-1 to the tune of Rs.15,478/- and thus, the complainant cannot seek the cancellation of the policy after taking the benefit from the insurance policy. Thus, the complaint has no merit and the same is hereby dismissed. The parties be communicated of the order accordingly and the file be consigned to the records after due compliance.

Announced                                                                                            (Subhash Goyal)

18.05.2016                                                                                                  President,

                                                                                                        District Consumer Disputes

                                                                                                        Redressal Forum, Gurgaon

 

(Jyoti Siwach)        (Surender Singh Balyan)

Member                 Member