Haryana

Bhiwani

CC/163/2017

Mahesh Kumar - Complainant(s)

Versus

Cholamandlam - Opp.Party(s)

Inperson

12 Mar 2024

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSASL COMMISSION, BHIWANI.

                                                                Complaint Case No. : 163 of 2017

                                                                Date of Institution    : 20.11.2017

                                                                Date of decision:      : 12.03.2024

 

Mahesh Kumar son of late Sh. Dalip Singh R/o village Manheru, Tehsil and District Bhiwani.

                                                            ...Complainant. 

 

                                                    Versus.

1. Indusind Finance Bank, Branch Bhiwani, Hansi Road, Bhiwani.

 

2. Cholamandalam MS General Insurance Co. Ltd., New No.319, Old No.154, Shaw Wallace Building, 2^nd Floor, Thambu Chetty Street, Parry’s Cornere,Chennai-600001.

 

...Opposite parties.

 

COMPLAINT U/S 12 OF CONSUMER PROTECTION ACT, 1986.

Before: -       Mrs. Saroj Bala Bohra, Presiding Member.

                    Ms. Shashi Kiran Panwar, Member.

Present:        Complainant in person.

Sh. R.K. Verma, Advocate for OP No.1.

Sh. Balbir Sharma, Advocate for OP No.2.  

  

                                                  ORDER

 

SAROJ BALA BOHRA, PRESIDING MEMBER:

1.                 Brief facts of this case are that complainant got insured his vehicle Scorpio bearing regn. No. HR-19H-0909 from OP No.1.  It is averred that with the said insurance policy, a health policy No.2842/00127252/000/00 Claim No.2842065909 dated 17.10.2016 was also issued for a sum of Rs.2.00 lac.  Complainant has stated that after 17.10.2016, he was suffering from hypertension and due to this, he was got admitted in Geetanjali Hospital, Hisar on 11.01.2017. So, he lodged a claim with OP insurance company but the claim was not released to him on the ground that complainant was having pre-existing disease. Complainant has submitted that as per treating doctor’s report, this problem was not a pre-existing to him. Hence, the present complaint has been preferred by complainant alleging mental and physical harassment to him besides huge monetary loss. In the end, prayed for issuance of directions to OPs to pay Rs.2.00 lac alongwith compensation for harassment besides litigation expenses.

2.                 Upon notice, OPs appeared and filed their separate written statements.

3.                 OP No.1 filed written statement qua cause of action, locus standi, maintainability and suppression of material facts. On merits, it is stated that on request of complainant, the OP bank sanctioned him a loan of Rs.4.00 lac for the abovesaid vehicle which was to be repaired in 34 monthly installments. Further, on his request, personal accidental and health insurance was taken from OPNo.2 and accordingly, policy was issued by OP No.2.  As such, there is no deficiency in service on its part and prayed for dismissal of the complaint with costs qua it.

4.                 OP No.2 filed written statement raising preliminary objections qua maintainability, locus standi, jurisdiction, complaint barred by limitation and suppression of material facts. On merits, it is submitted that the complainant was suffering the disease for the last five years prior to commencement of the policy as opined by the treating doctor but this fact was not disclosed by complainant at the time of taking the policy. So, his claim for Rs.16,394/- was repudiated as found not covered under the policy. As such, complainant is not entitled to get any amount from the OP insurance company and prayed for dismissal of the complaint.

5.                 In evidence of complainant, documents Annexure C-1 to Annexure C-4 were tendered and closed the evidence on 14.02.2020.

6.                 On the other side, documents Annexure R-1 to Annexure R-3 were tendered in evidence of OP No.1 and closed the same on 09.04.2021.

7.                 Documents Annexure R-4 to Annexure R-6 were tendered in evidence of OP No.2 and closed the same on 14.09.2022.

8.                 We have heard complainant as well as learned counsel for the OPs and perused the record carefully.

9.                 OP No.1 has averred in its pleadings that it has only provided loan facility to the complainant and issue of the alleged policy is a concern of OP No.2 insurance company. The alleged policy to the complainant has been admitted by OP No.2 but denied the claim to complainant on ground of pre-existing disease. Complainant has alleged that he was not having any such disease prior to commencement of the policy and the treating has also made endorsement to this effect (Annexure C-4). Perusal of this documents shows that complainant went to the hospital with complaints of sudden onset of chills, SOB, increasing B.P. readings last 2 days, but this was not an opinion of the doctor but this was written as told by the patient/complainant.

10.               OP No.2 insurance company to prove the fact that complainant was suffering from the alleged disease for the last 5 years has placed on record investigator’s report (Annexure R-4) which recommended repudiation of the claim on ground of pre-existing disease. Further, the Op has relied upon a certificate of doctor (Annexure R-6) wherein name of patient has not been mentioned but mentioned HTN x 5 years.  Learned counsel for OP No.2 in support of his case has placed reliance on case laws delivered by Hon’ble National Consumer Disputes Redressal Commission, New Delhi in RP No.2488/2015 titled Surinder Kaur Vs. National Insurance Co. Ltd. decided on 04.05.2016. Case law titled New India Assurance Co. Ltd. Vs. Shri Vishwanath Manglunia RP N.164 of 2006 decided on 12.04.2010. Aman Kapoor Vs. National Insurance Co. Ltd. & Ors. R.P. No.429 of 2017 decided on 17.04.2017. We have gone through the aforementioned case laws.

11.               After hearing learned counsels for the OPs and the complainant, we are of considered opinion that OP insurance company has wrongly, illegally and arbitrarily denied claim to the complainant in terms of law laid down by Hon’ble National Consumer Disputes Redressal Commission, New Delhi in case titled Bajaj Allianz Life Insurance Co. Ltd. and 2 ors. Vs. Kanduru Gangadhara Rao  2021 decided on 07.10.2021 CPJ-244 wherein it is held that “Mere filing of some hospital records was not sufficient to show that the policy holder was suffering from the ailment at the time of filing of proposal form.”  The Hon’ble Punjab & Haryana High Court in CWP No.26178 of 2016 titled as National Insurance Co.Ltd. Vs. Sandeep & others reported in 2017 (1) RCR (Civil) Page 621 wherein it has been  held that “Insurance companies give lucrative offers to attract customers-However, the moment any insured puts even the most genuine claim, seldom said claim would be accepted by any insurance company.”

12.               Perusal of discharge card (Annexure C-4) reveals that complainant was admitted in the hospital on 11.01.2017 and was discharged on 13.01.2017 and as per document Annexure C-2, he lodged claim for Rs.16,394/- before the OP insurance company but the same was denied as discussed above.  As such, the complainant is entitled to a sum of Rs.16,394/- from OP No.2.  Further, this litigation must have caused monetary loss as well as mental and physical harassment to the complainant.  Accordingly the complaint is allowed and OP No.2 insurance company is directed to comply with the following directions within thirty days from the communication of this order:-

(i)       To pay a sum of Rs.16,394/- (Rs. Sixteen thousand three hundred ninety four) to the complainant alongwith simple interest @ 9% per annum from the date of institution of complaint to till its realization.

2. Also to pay a sum of Rs.20,000/- (Rs. Twenty thousand) on account of harassment caused to the complainant.
3. And to pay a sum of Rs.5500/- (Rs. Five thousand five hundred) on account of litigation expenses.

                    In case of default, all the awarded amounts shall further attract simple interest @ 12% per annum for the period of default. 

                    If this order is not complied with, then the complainant shall be entitled to the execution petition under section 71 of Consumer Protection Act, 2019 and in that eventuality, the opposite party may also be liable for prosecution under Section 72 of the said Act which envisages punishment of imprisonment, which may extend to three years or fine upto rupees one lac or with both.  Copies of this order be sent to the parties concerned, free of costs.  File be consigned to the record room after due compliance.  

Announced.

Dated: 12.03.2024.