Haryana

StateCommission

A/1552/2017

STAR HEALTH AND ALLIED INSURANCE CO.LTD. - Complainant(s)

Versus

DHANVINDER SINGH - Opp.Party(s)

SAHIL ABHI

21 Aug 2018

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

 

                                                 

                                                                   First Appeal No  :   1552 of 2017

Date of Institution:  15.12.2017

                                                                   Date of Decision:   21.08.2018

 

 

1.      Star Health and Allied Insurance Company Limited, SCO No.242, Sector 12, 1^st Floor, Urban Estate, Karnal through its Manager.

 

2.      Star Health and Allied Insurance Company Limited, KRM Centre, 6^th Floor, No.2, Harrington Road, Chetpet, Chennai through its Managing Director.

                                       Appellants-Opposite Parties No.1 & 2

 

Versus

 

1.      Dhanvinder Singh son of Baldev Singh, resident of Village and Post Office Khanpur Kollan, Tehsil Thanesar, District Kurukshetra.

Respondent-Complainant

 

2.      Ms. Beena Mehta wife of Dharam Pal Mehta, resident of #444, Sector 7, Urban Estate, Kurukshetra, Tehsil Thanesar, District Kurukshetra.

Respondent-Opposite Party No.3

 

 

CORAM:   Hon’ble Mr. Justice Nawab Singh, President.

                   Shri Balbir Singh, Judicial Member.

 

 

Present:     Shri Sahil Abhi, Advocate for the appellants.

                   Shri Amit Chaudhary, Advocate for the respondent-complainant

                   None for the respondent No.2

 

 

                                                   O R D E R

 

 

NAWAB SINGH J.(ORAL)

 

          Dhanvinder Singh-insured (complainant) purchased Family Health Optima Insurance Policy from Star health and Allied Insurance Company Limited-opposite parties No.1 and 2 (for short ‘Insurance Company’). Period of insurance was April 19^th, 2013 to April 18^th, 2014. Limit of coverage was Rs.5,00,000/-. Thereafter, it was renewed from May 06^th, 2014 to May 05^th, 2015 and May 22^nd, 2015 to May 21^st, 2016 vide Annexures 1 and 2. During the currency of the insurance policies, he was hospitalized thrice from March 23^rd, 2015 to April 01^st, 2015 and expenses incurred on his treatment was Rs.8,73,589/-.  He lodged claim with the Insurance Company but the same was repudiated on the ground that the complainant was a known case of hypertension.

2.      Aggrieved of the repudiation, he filed complaint under Section 12 of the Consumer Protection Act, 1986 before the District Consumer Disputes Redressal Forum, Kurukshetra (for short ‘District Forum’). The District Forum vide impugned order dated October 18^th, 2017, directed the Insurance Company to pay Rs.8,73,589/-.

3.      Against the said order, the Insurance Company has filed the instant appeal.

4.      The only contention raised by learned counsel for the Insurance Company is that the complainant was entitled to Rs.6,25,000/- instead of Rs.8,73,589/- awarded by the District Forum.

5.      As per the period of insurance policy, that is, May 06^th, 2014 to May 05^th, 2015 (Annexure 1) (during the period the complainant incurred expenses on his treatment), the limit of coverage was Rs.6,25,000/-. Since, the limit of coverage was Rs.6,25,000/-, so, question of directing the Insurance Company to pay Rs.8,73,589/- was not justifiable. Accordingly, the impugned order is modified to the extent that the Insurance Company shall pay Rs.6,25,000/- to the complainant within a period of 60 days from the date of receipt of this order.  The appeal stands disposed of accordingly.

6.      The statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the complainant against proper receipt and identification in accordance with rules, after the expiry of period of appeal/revision, if any.

 

 

Announced 21.08.2018

(Balbir Singh) Judicial Member

(Nawab Singh) President

U.K