BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, MYSORE-570023

CONSUMER COMPLAINT NO.343/2015

DATED ON THIS THE 7^th July 2017

      Present:  1) Sri. H.M.Shivakumara Swamy

B.A., LLB., - PRESIDENT   

    2) Smt. M.V.Bharathi                    

                                   B.Sc., LLB., -  MEMBER

                     3) Sri. Devakumar.M.C.                  

                                          B.E., LLB., PGDCLP,    - MEMBER

Sri DEVAKUMAR.M.C,

Member

1.     The complainant has filed the complaint under section 12 of the C.P.Act 1986, against the opposite parties, alleging deficiency in service and unfair trade practice and seeking a direction to opposite party Nos.1 and 2 to refund the amount, which was transferred from complainant’s account on 10.11.2014 with cost and to pay the circumcision and meatoplasty surgery bills with cost and Rs.10,000/- towards deficiency in service and unfair trade practice with cost and such other reliefs.
2.     The complainant obtained a health insurance policy from opposite party No.2 through opposite party No.1.  The complainant had a bank account with opposite party No.1.  Suffering from pain, while passing urine, he got treatment at opposite party No.3 Hospital, between 03.01.2014 to 04.01.2014.  He also got removed an earlier implant, by the orthopaedic surgeon.  The opposite party No.2 not settled the hospital expenses, same paid by complainant only.  The complainant claimed the expenses under the policy.  The explanation relating to implant surgery, was furnished to opposite party No.2.  Even after, the opposite party Nos.1 and 2 failed to settle the claims.
3.     In the meanwhile, after the expiry of the policy period, the opposite party No.1, transferred the premium amount to opposite party No.2, from complainant’s account.  However, complainant was not willing to continue with insurance policy.  As such, alleging deficiency in service and unfair trade practice, filed the complaint seeking reliefs.
4.     Opposite party No.1 remained absent, hence placed exparte.
5.     Opposite party No.2 filed version and admits the issue of health insurance policy on receipt of proposal form and the premium.  It submits the complainant was suffering from diabetes and the urine problems since past 4 to 5 months prior to issuance of the policy, but the same was not disclosed in the proposal form.  Complainant got admitted to opposite party No.3 hospital with the complaint of pain while passing urine and undergone surgery.  Further, he voluntarily decided and requested the surgeon to remove the implant, which was inserted in his right palm. On receipt of the claim under the policy, the opposite party requested to furnish relevant documents pertaining to his earlier treatment.  But, the complainant failed to submit the same, hence, the claim has been closed as “No claim”.
6.     Further based on the instructions, for renewal of the policy, the premium amount has been paid to opposite party No.2 by opposite party No.1.  The complainant has not intimated the opposite party No.1 bank for stop payment/cancellation of ECS.  The non-disclosure of the relevant information amounts to suppression of material facts, as such, claims that, there is no deficiency in service and hence prays for dismissal of complaint against them.
7.     Opposite party No.3 filed its version and submits the complainant admitted on 03.01.2014 with a complaint of pain while passing urine. The doctor (urologist) suggested for a surgery – circumcision and meatoplasty.  The complainant informed about his implant history to the orthopaedic surgeon.  On his suggestion, the complainant underwent both surgeries and got discharged.  Further, since the complainant has not sought for any relief against opposite party No.3, they pray for dismissal of the complaint against them with cost.
8.     To prove the facts, the complainant lead evidence by filing affidavit and relied on several documents.  The opposite party Nos.2 and 3 have also lead their evidence by filing respective affidavit and relied on documents.  Written arguments filed by opposite party Nos.2 and 3 only.  After hearing oral submissions, the matter posted for orders.
9.     The points arose for our consideration are:-

1. Whether the complaint is maintainable?
2. Whether the complainant establishes the deficiency in service and unfair trade practice by the opposite parties, in not settling the claims made under the policy and thereby he is entitled for the reliefs sought?
3.  What order?

10.    Our findings on the aforesaid points are as follows:

Point No.1 :- In the negative.

Point No.2 :- Does not call for discussion.

Point No.3 :- As per final order for the following

:: R E A S O N S ::

11.  Point No.1:- The complainant obtained a health insurance policy from opposite party No.2, on payment of premium amount.  The complainant suppressed his previous ailment and treatment details in the proposal form submitted to opposite party Nos.1 and 2 while taking the insurance policy.
12. On investigation of the claim with the documents, the opposite party No.2, found that the complainant was suffering from diabetes and had undergone an implant surgery, prior to taking the policy the same was suppressed by complainant.  The opposite party sought necessary particulars about earlier treatment from the complainant. On failure to furnish the same, the opposite party No.2, repudiated the claim for suppression of material facts.  The insurance being a contract, the parties are bound to disclose all the necessary information while taking an insurance policy.  Any suppression of material facts, violates the policy terms and conditions and the policy becomes void.  As such, the opposite party’s have rightly repudiated the claims and the complaint filed is not maintainable for suppression of material facts.  Further, the complainant is not entitled for any reliefs sought.  Accordingly, the Point No.1 is answered in the negative.
13.   Point No.2:- In view of the observations in point No.1, this point does not call for discussion.
14.    Point No.3:- From the above observations, we proceed to pass the following

:: O R D E R ::

1. The complaint is hereby dismissed as not maintainable.
2. Give the copies of this order to the parties, as per Rules.

(Dictated to the Stenographer transcribed, typed by her, transcript corrected by us and then pronounced in open court on this the 7^th July 2017)