Complaint Case No. 101/2016

Smt. Kusumlata W/o  Late Sri Suresh Chandra Gupta R/o 19/337 A Moh. Gandhi Nagar Aligarh

V/s

1. Branch Manager, Life Insurance Company Ltd, CBO 2, Aligarh
2. Divisional Manager, Life Insurance Company Ltd, Divisional office Masudabad, Aligarh
3. Regional Manager, Regional Office,  Life Insurance Company Ltd North Central Regional office M.G. Road, Kanpur
4. Ajesh Kumar, Beema Lokpal Westren U.P. & Uttrakhand, Noida  

CORAM

 Present:

1. Shri Hasnain Qureshi, President
2. Shri Alok Upadhayay, Member
3. Smt. Purnima Singh Rajpoot, Member
4.  

PRONOUNCED by Shri Hasnain Qureshi, President

JUDGMENT

1. The present complaint has been filed by the complainant before this commission for  payment of insured sum Rs.239247 with cost.   
2. Complainant has stated that her husband Suresh Chandra Gupta had obtained policy no. 563857343 from the LIC on 13.4.2010 under health protection plus scheme 902 and her husband had nominated the complainant. The complainant’s husband was brought to Dr. Navneet Maheshwari on 25.1.2014 on feeling unwell from where he was referred to J.N. medical College hospital Aligarh on 27.1.2014. On 27.1.2014 he was taken to Varun Trama Center from there he was sent to Sir Ganga Ram Hospital, Delhi and he died on 29.1.2014 at 12.25AM. Complainant submitted all the papers at Aligarh office on 11.4.2014 but a letter was received from Regional office on 20.7.2014 wherein the reason of no claim was stated as the period for admission of the insured is less than 52 hours.
3. Ops submitted in WS that the complainant’s husband Suresh Chandra Gupta had obtained policy under Health Protection plus scheme 902. It has been falsely alleged that the complainant’s husband was admitted by Dr. Navneet Maheshwari on 25.1.2014 and was referred to another hospital. Complainant has alleged that her husband was admitted at  Medical college, Aligarh on 27.1.2014 at 3.30 PM and was discharged on 27.1.2014 but there is no time of discharge written on the discharge slip. No time of discharge is written on discharge slip of Varun Trama Centre where complainant’s husband is alleged to have been admitted at 9 A.M. on 27.1.2014. Complainant’s husband has been shown to have been admitted in medical college on 27.1.2014 at 3.30 PM and in Varun Trama Centre on 27.1.2014 at 9A.M. Complainant has shown the admission of her husband in Sir Ganga Ram on 28.1.2014 at 6.56 AM but the time of HTF is not there and at 12.25 on 29.1.2014 complainant’s husband has been shown to have been discharged. It is not proved from the papers that the complainant husband   remained admitted for 52 hours and it is necessary under the policy scheme 902 to remain admitted in hospital not less than 52 hours and it is also necessary to have been admitted within 12 hours after discharge from the first hospital . Complainant’s claim was rejected on 23.8.2014 because the period of admission 52 hours could not be completed.   
4. Complainant has filed his affidavit and papers in support of his pleadings. Ops also filed their  affidavits and papers in support of their pleadings.
5. We have perused the material available on record and heard the parties.
6. First question of consideration before us complainant is entitled to any relief?
7. It is evident from the record that the complainant husband   remained admitted less than  52 hours and it is necessary under the policy scheme 902 to remain admitted in hospital not less than 52 hours and it is also necessary to have been admitted within 12 hours after discharge from the first hospital. The terms and conditions of the policy could not be fulfilled and therefore complainant is not entitled for the claim.
8. Question  formulated above is decided against the complainant.      
9. We hereby dismiss the complainant.
10. A copy of this judgment be provided to all the parties as per rule as mandated by Consumer Protection Act, 2019. The judgment be uploaded forthwith on the website of the commission for the perusal of the parties.
11. File be consigned to record room along with a copy of this judgment.