Delhi

StateCommission

CC/92/2016

SMT. GURINDER JANMEJA - Complainant(s)

Versus

CIGNA TTK HEALTH INSURANCE CO. LTD. - Opp.Party(s)

HIMANSHU PATHAK

18 Feb 2016

ORDER

IN THE STATE COMMISSION : DELHI

(Constituted under Section 9 of the Consumer Protection Act, 1986)

Date of Arguments: 18.02.2016

Date of Decision: 22.02.2016

Complaint No.92/2016

 

In the matter of:

Smt. Gurinder Janmeja,

W/o Late Shri Sudhir Janmeja,

R/o A-5, First Floor,

Ashok Nagar,

Ghaziabad-201001.

Uttar Pradesh (UP).                                                          …..........Complainant

 

Versus

1. Cigna TTK Health Insurance Company Ltd.,

Branch Office at:

E-75, 7^th Floor, Himalaya House,

23,     K.G. Marg, Cannaught Place,

New Delhi.                                                                               

                                                    

Also at corporate office:

 

Cigna Corporate Headquarter,

900, Cottage Grove Road,

Bloomfield, C-7-06002,

Two liberty place,

1601 Chestnut Street,

Philadelphia, PA-191920003.

 

2. Life Insurance Company of North America,

1601,Chestnut Street,

Philadelphia, PA-191920003.

 

3. Lion Clubs International,

19, Nirlong House, 4^th Floor,

254-B, Dr. Annie Besant Road,

Worli, Mumbai-400030.

 

 

 

CORAM

O. P. Gupta, Member (Judicial)

S. C. Jain, Member

 

1.     Whether reporters of local newspaper be allowed to see the judgment?

2.      To be referred to the reporter or not?

 

 O.P. Gupta, Member (Judicial)

 

1. The case set up by the complainant is that OP-1 is Health Insurance Company, OP-2 is under writing stock company and OP-2 is community service club organisation of which husband of the complainant was a member. The husband of the complainant boarded train at New Delhi Railway Station for Ahemdabad to attend all India Officers Meeting and met with a fatal heart attack and expired on 30.01.2014. OP-3 in order to protect its members and volunteers and in order to reduce its own liability subscribed accident insurance policy of Op-1 through OP-2. He was entitled to accidental Death Policy of $25000 and the complainant lodged claim of the said amount.  OP-3 vide mail dated 19.05.2014 informed that letter dated 08.05.2014 was sent by OP-1 informing that it was an accident only policy, does not cover loss caused at sickness. The claim was rejected vide letter dated 09.07.2014 on the ground that deceased did not suffer any injury or cover accident, death was result of heart attack and clause listed on certification of death was noted as natural. The complainant referred intra departmental appeal before concerned authority of OP-1 but appellate authority upheld the decision vide order dated 08.07.2014.  The appellate authority observed that unless the person suffers an external visible injury, OP-1 would not be liable to reimburse the benefit of policy. Hence, this complaint for awarding $25000 equivalent to over Rs.17 lacs @Rs.68/- per dollar and compensation of Rs.7.5 lacs.

 

2. We have gone through the material on record and heard arguments on admission. Copy of policy placed at page-24 defines the policy term as 1^st July, 2001 to 1^st July, 2004. No renewal thereafter is placed on record.  The incident is not covered by the period mentioned in the policy.

 

3. We do not find any merit in the plea that death was by accident. Heart attack is disease.  That is why the appellate authority of OP-1 has observed that there was no external injury nor any visible mark.  Certificate of death also shows cause of death is natural.

 

4. The complaint is dismissed in limini.

 

5. A copy of this order be sent to both the parties free of cost.

 

(O.P. Gupta)

Member (Judicial)

                         

 

                                                                                                          (S. C. Jain)

Member​