BEFORE THE DISTRICT CONSUMER DISPTUES REDRESSAL FORUM, KAITHAL.
Complaint no.72/16.
Date of instt.: 10.03.2016.
Date of Decision: 22.09.2016.
Pawan Kumar aged 29 years S/o Sh. Ishwar R/o Kharak Pandwa, Tehsil Kalayat, District Kaithal.
……….Complainant.
Versus
HDFC Life, Dhand Road near ICICI Bank, Kaithal through its Manager.
..……..Opposite Party.
COMPLAINT UNDER SEC. 12 OF CONSUMER PROTECTION ACT, 1986.
Before: Sh. Jagmal Singh, President.
Sh. Rajbir Singh, Member.
Smt. Harisha Mehta, Member.
Present : Complainant in person.
Sh. Vikram Tiwari, Advocate for the opposite party.
ORDER
(JAGMAL SINGH, PRESIDENT).
The complainant has filed the present complaint under Section 12 of Consumer Protection Act, 1986, with the averments that approximately six month ago, the complainant purchased the scheme of life care from the office of Op and paid an amount of Rs.4750/- and the said scheme was valid w.e.f. 12.10.2015. It is alleged that on 01.11.2015 the complainant was suffering from fever and he was admitted in the Jaipur Hospital, Kaithal and the complainant incurred Rs.50,000/- on his treatment. It is further alleged that the complainant lodged the claim with the Op but the Op did not settle the claim of complainant. This way, the Op is deficient in service. Hence, this complaint is filed.
2. Upon notice, the opposite party appeared before this forum and filed written statement raising preliminary objections with regard to maintainability; cause of action; locus-standi; that the complainant has concealed the true and material facts from this Forum. The true facts are that as per the product specification as provided under Section 7, there is a waiting period of 30 days from the date of commencement of the policy and if the life assured suffers any illness within the waiting period, then in that eventuality, the Op is not liable to make any payment towards the expenditure amount so spent upon hospitalization and treatment of the life assured. There is no deficiency in service on the part of answering Op. On merits, the contents of complaint are denied and so, prayed for dismissal of complaint.
3. In support of his case, the complainant tendered in evidence affidavit Ex.CW1/A and closed evidence on 19.07.2016. On the other hand, the Op tendered in evidence affidavit Ex.RW1/A and documents Mark-R1 to Mark-R7 and closed evidence on 05.09.2016.
4. We have heard both the parties and perused the case file carefully and minutely and have also gone through the evidence led by the parties.
5. The complainant reiterated all the points mentioned in the complaint. The complainant argued that he joined the scheme of life care with the Op and the Op issued a card in which the valid date has been shown as 12.10.2015 and paid an amount of Rs.4750/-. He further argued that on 01.11.2015 the complainant was suffering from fever and was admitted in the Jaipur Hospital, Kaithal and the complainant incurred Rs.50,000/- on his treatment. He further argued that the complainant lodged the claim with the Op but the Op did not settle the claim of complainant. On the other hand, ld. Counsel for the Op argued that as per terms and conditions of the policy, there is a waiting period of 30 days from the date of commencement of the policy and if the life assured suffers any illness within the waiting period, then in that eventuality, the Op is not liable to make any payment towards the expenditure amount so spent upon hospitalization and treatment of the life assured.
6. From the pleadings and evidence of the parties, it is clear that the complainant purchased the policy namely “Health Assure Verification Form” dt. 10.10.2015, copy of which Mark-R1 is placed on the file. It is not disputed between the parties that the complainant had suffered from fever of Dangue from 01.11.2015 and he was admitted in Jaipur Hospital on 01.11.2015 and was discharged on 03.11.2015. It is also not disputed that the complainant had lost the claim with the Op. It is also not disputed that the Op had rejected the claim of complainant on the ground that as per clause 7 of the policy, there was a waiting period of 30 days and the complainant had suffered from Dengue fever within 30 days from the date of commencement of policy. The main controversy between the parties is that whether the Op had rejected the claim of complainant in terms and conditions of the policy or not? The ld. Counsel for Op has referred clause 7 of the policy, Mark-R1 which runs as under:-
“7. Exclusions:
This policy has an initial waiting period of 30 days which applies from the date of commencement of cover or from date of reinstatement if there is a break in the policy. However, hospitalization caused due to accident is covered during this waiting period. This waiting period does not reapply if the policy is renewed without a break.”
So, in view of above-said exclusion clause No.7 of the policy, it is clear that there was a waiting period of 30 days from the date of commencement of the policy. It is admitted case of the complainant that he suffered from Dengue fever on 01.11.2015. It is clear from the policy that the same was effective from 10.10.2015. So, it is very much clear that the life assured suffered with the illness in question within the waiting period. The policy is a contract between the parties, hence, as per the exclusion clause of the policy, the complainant is not entitled for any claim. Hence, the complainant has failed to prove any deficiency on the part of Op.
8. Thus, in view of above discussion, we find no merit in the present complaint and we hereby dismiss the same. No order as to costs. A copy of this order be sent to both the parties free of costs. File be consigned to the record room after due compliance.
Announced.
Dt.22.09.2016.
(Jagmal Singh),
President.
(Harisha Mehta), (Rajbir Singh),
Member. Member.
