In the Court of the
Consumer Disputes Redressal Forum, Unit -I, Kolkata,
8B, Nelie Sengupta Sarani, Kolkata-700087.
CDF/Unit-I/Case No. 23 / 2008.
1) Shiv Ratan Sharama,
26, Dobson Road, Falt no. 5E, Howrah-711101. ---------- Complainant
---Versus---
1) Aviva Life Insurance Company Pvt. Ltd.,
Registered office : 5th Floor, JMD Regent Square Gurgaon,
Mehrauli Road, Gurgaon-122001.
And regional office at 2nd Floor, A.G. Towers,
125/1, Park Street, Kolkata-700017.
2) Aviva Life Insurance Com. Ltd.,
Braburn Road, Kolkata-700001. ---------- Opposite Parties
Present : Sri Sankar Nath Das, President.
Dr. A. B. Chakraborty, Member
Order No. 2 8 Dated 1 7 / 0 2 / 2 0 1 2 .
The petition of complaint u/s 12 of the C.P. Act, 1986 has been filed by the complainant Shiv Ratan Sharma against the o.ps. Aviva Life Insurance Co. Pvt. Ltd. The case of the complainant in short is that in 2004 complainant took insurance policy no.CLG/1085033 and CLI 1085913 on payment of premium of Rs.20,000/- every year. As per representation of the agent of the o.p., complainant was of the impression that he could avail the rider i.e. benefit on accidental death and disablement, critical illness and permanent total disability and hospital cash benefit. Complainant in total paid of Rs.60,000/- towards premium for two policies for a period of three years. In November 2005 complainant was admitted to Apollo Gleneagles Hospital, Kolkata as he suffered from heart attack and for such treatment complainant made a claim of Rs.1,48,000/- towards reimbursement of the cost of the treatment and the sum insured upto Rs.2 lakhs. But o.ps. repudiated the said claim on the plea that complainant did not opt any rider in support of his claim. Hence the instant case.
O.ps. had entered their appearance in this case by filing w/v and denied all the material allegations labeled against them and prayed for dismissal of the case.
Decision with the reasons:
We have gone through the pleadings of the parties, evidence and documents in particular. It is apparent from the record that at the time of insurance medical examination was held by o.ps. and plead taken by o.ps. is not sustainable on the ground that there is no tick mark indicating option of rider. So, the plea is considered baseless. The very philosophy of the insurance premium is that insured commenced from the date of first payment and the plea of o.p. on flimsy ground cannot be considered as a genuine ground and it is to be construed that the plea has been taken by o.p. to avoid from making payment unnecessarily. It is seen from annex-A filed by complainant that his date of birth is 13.3.53 and it is to be construed that a person having such an age will definitely opt for riders.
That being the position considering the findings made above and on perusal of the entire materials on record available we are of the view that o.ps. had clear deficiency towards its consumer / complainant being a service provider and complainant is entitled to relief as prayed for made in the prayer portion of the petition of complaint.
Hence, ordered,
That the petition of complaint is allowed on contest with cost against the o.ps. O.ps. are directed to pay a sum of Rs.1,48,000/- (Rupees one lakhs forty eight thousand) only by account payee cheque to the complainant together with interest @ 9% p.a. from the date of claim till the date of realization. O.ps. are further directed to pay compensation of Rs.10,000/- (Rupees ten thousand) only for harassment and mental agony and litigation cost of Rs.5000/- (Rupees five thousand) only within 45 days from the date of communication of this order i.d. an interest @ 9% p.a. shall accrue over the entire amount due to the credit of the complainant till full realization.
Supply certified copy of this order to the parties.
_____Sd-_______ ______Sd-__________
MEMBER PRESIDENT
