COMPLAINT FILED: 25.02.2009<br /> <br /> BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM AT BANGALORE (URBAN)<br /> <br /> 12th AUGUST 2009<br /> <br /> PRESENT :- SRI. A.M. BENNUR PRESIDENT<br /> SMT. M. YASHODHAMMA MEMBER <br /> SRI. A. MUNIYAPPA MEMBER <br /> <br /> COMPLAINT NO.465/2009<br /> <br /> <br /> COMPLAINANT Sri. R.Venkatesh,<br /> S/o Late D.Ramu,<br /> Aged about 29 years,<br /> R/o No.432, 1st Floor,<br /> ‘Hemavathi Nilaya’,<br /> Ganapathipura,<br /> Bangalore – 560 062<br /> <br /> <br /> V/s.<br /> <br /> <br /> OPPOSITE PARTY The Regional Manager,<br /> The Bajaj Allianz General<br /> Insurance Company Ltd.,<br /> No.31, T.B.R. Tower,<br /> 1st Cross, New Mission Road,<br /> Bangalore – 560 002.<br /> <br /> <br /> O R D E R<br /> <br /> This is a complaint filed U/s. 12 of the Consumer Protection Act of 1986 by the complainant seeking direction to the Opposite Party (herein after called as O.P) to settle the insurance claim for Rs.3,00,000/- and for such other reliefs on an allegations of deficiency in service. <br /> 2. The brief averments, as could be seen from the contents of the complaint, are as under.<br /> <br /> 3. Complainant has took a comprehensive health coverage policy from OP on 24.09.2008 by paying a premium of Rs.8,890/-. There is a coverage for Rs.12,50,000/- which includes personal accident coverage for the death and hospital expenses. Under the said policy himself his wife and son are the beneficiaries. His son Master Jeevan aged about one year, started severe vomiting on 02.10.2008 hence he was admitted to K.R. Hospital Bangalore. Ultimately he expired on 04.10.2008. After the death of his son complainant made a claim to OP to settle the sum assured in the policy. Unfortunately OP repudiated the claim on 08.12.2008 without due application of the mind. Hence complainant felt the deficiency in service on the part of the OP. Under such circumstances he is advised to file this complaint and sought for the relief accordingly.<br /> <br /> 4. On appearance, OP filed the version denying all the allegations made by the complainant in toto. According to OP the said policy was in force for one year from 24.09.2008 to 23.09.2009. The liability of the OP under the policy is subject to terms and conditions and the exclusion clause. The son of the complainant fell sick and later on expired during the first 30 days from the commencement of the policy. Hence OP is justified in repudiating the said claim. Before repudiation it, but applied the mind and took the opinion from the panel Doctors. OP is justified in invoking the exclusion clause 4(c). There is no deficiency in service on the part of the OP. complaint is devoid of merits. Among these grounds, OP prayed for the dismissal of the complaint.<br /> <br /> 5. In order to substantiate the complaint averments, the complainant filed the affidavit evidence and produced some documents. OP has also filed the affidavit evidence and produced the documents. Then the arguments were heard.<br /> <br /> 6. In view of the above said facts, the points now that arise for our consideration in this complaint are as under:<br /> <br /> Point No.1 :- Whether the complainant has proved <br /> the deficiency in service on the part of the OP?<br /> <br /> Point No.2 :- If so, whether the complainant is <br /> entitled for the reliefs now claimed?<br /> <br /> Point No.3 :- To what Order?<br /> <br /> <br /> 7. We have gone through the pleadings of the parties, both oral and documentary evidence and the arguments advanced. In view of the reasons given by us in the following paragraphs our findings on:<br /> <br /> Point No.1:- In Affirmative.<br /> <br /> Point No.2:- Affirmative in part.<br /> <br /> Point No.3:- As per final Order.<br /> <br /> <br /> <br /> <br /> R E A S O N S<br /> <br /> 8. At the outset it is not at dispute that the complainant took the comprehensive policy from OP on 24.09.2008 by paying a premium of Rs.8,890/-. Under the said policy OP covered the risk of complainant his wife and son. We have gone through the copy of the policy. According to the complainant OP covered personal accident for death, hospital expenses etc. <br /> <br /> 9. Now it is the grievance of the complainant, that his son Jeevan fell sick on 02.10.2008, though he was taken of hospital he could not survive. On 04.10.2008 he expired. Complainant has spent nearly Rs.30,000/- towards the treatment. Then made the claim to OP to settle the policy benefits. Unfortunately OP repudiated the claim on 08.12.2008. The copy of the repudiation letter is produced. The main ground raised by the OP is that the death occurred within 30 days from the date of policy. According to OP the son of the complainant expired during first 30 days from the commencement of the policy. Hence no liability lies with them to settled the insurance claim. We do not find substance in the said defence. On the face of it the repudiation appears to be unjust and improper without due application in mind. OP has covered the risk of the life of the complainant, his son and wife and when the son of the complainant died during the coverage of the insurance policy it is encumbant on the part of the OP to settle the insurance claim. Under the circumstances unilaterally OP cannot invoke the exclusion clause 4(c). We are satisfied that the complainant is able to prove the deficiency in service on the part of the OP. Of course complainant is not insisting for the payment of the medical expenses. Complainant has satisfactorily established that during the coverage of insurance his son expired hence for this reason complainant is entitled for relief claimed. Accordingly we answer point nos.1 and 2 and proceed to pass the following: <br /> <br /> O R D E R<br /> <br /> The complaint is allowed in part. OP is directed to settle the insurance for Rs.2,50,000/- and pay the same to the complainant within 30 days from the date of communication of this order. In view of the nature of dispute no order as to costs.<br /> <br /> In default of payment of the settled amount in due in time the complainant is entitled to claim interest at the rate of 9% p.a. on Rs.2,50,000/- from the date of repudiation till realization, and also entitled for litigation cost of Rs.1,000/-. <br /> <br /> (Dictated to the Stenographer and typed in the computer and transcribed by him, verified and corrected, and then pronounced in the Open Court by us on this the 12th day of August 2009.) <br /> <br /> <br /> <br /> <br /> MEMBER MEMBER PRESIDENT<br /> <br /> s.n.m. <br /> <br />