DISTRICT CONSUMER DISPUTES REDRESSAL FORUM-II

Udyog Sadan, C-22 & 23, Qutub Institutional Area

(Behind Qutub Hotel), New Delhi-110016.

Case No.72/2014

Sh. Amit Goyal

AL-72, Shalimar Bagh,

New Delhi-110088                                                ……Complainant

Versus

1.       IFFCO Tokio Insurance Co. Ltd.

          IFFCO Sadan, C1 Distt. Centre

          Saket New Delhi

2.       INTERMEDIARIES:- Fairdeal Insurance Brokers Pvt. Ltd.

          16, Avtar Enclave, 1^st Floor, Paschim Vihar

          New Delhi-110063                                      ……Opposite Parties

                                                          Date of Institution          : 19.02.14                                                             Date of Order       :  23.03.16

Coram:

Sh. N.K. Goel, President

Ms. Naina Bakshi, Member

O R D E R

Briefly stated, the case of the Complainant is that he purchased medical insurance policy for himself, his wife and two children from OP-1 on 21.03.13 and paid Rs.9717/- vide cheque No.719295 drawn on Punjab National Bank in favour of the OP-1 on 10.03.2013. He had also purchased a health insurance service for himself as well as other family members from Appolo Munich Health Insurance Co. for the period from 14.03.12 to 13.03.13 and the insurance broker of OP-1 later on offered to post his medical insurance policy to IFFCO Tokio from Appolo Munich with all portability benefits  agreed and changed for insurance policy from Appolo Munich to IFFCO Tokio insurance Co. (OP) and after depositing the  above amount of Rs. 9717/- he was issued policy No. 52259884 on 31.3.13 covering his whole family. He received a letter from the OP for cancellation of the policy No.52259884 wherein the OP  mentioned the reason that he had concealed the material fact relating to medical treatment that the person insured was suffering from CAD disease. He sent a letter dated 12.07.13 to the Chairman-Cum-Managing Director of OP Company to restore the policy and also enclosed the letter from family physician but the OP neither paid any heed nor sent any reply. Hence, there is a deficiency in service on the part of OP.  Complainant has prayed as under:-

1. Direct the OP to pay/refund an amount of Rs.40,000/- to the Complainant alongwith 24% interest per annum from the date of the said agreement till date.
2. Direct the OP to pay a sum of Rs.60,000/- as compensation towards the physical strain and mental agony suffered by the Complainant.
3. Direct the OP to pay Rs.5,000/- as litigation expenses.

OP No.1 & 2 have been proceeded exparte vide order dated 11.08.14 & 13.06.14 passed by our Predecessors.

Complainant has filed his own affidavit and the affidavit of Dr. Suresh Gupta in evidence and written arguments. We have heard the Complainant and have also gone through the file very carefully.

Complainant has failed to mark exhibit nos. or annexure nos. on the corresponding documents.

The date on which the complainant had received the letter from the OPs thereby cancelling the policy in question has not been mentioned in the complaint or in the affidavit of the complainant.  Even the copy of the said letter has not been exhibited or marked on the file.  From a perusal of the reply dated 28.10.13 sent by the OPs to the letter dated 12.7.13 of the complainant, it clearly transpires that the two daughters of the complainant, namely, Nyasa Goyal and Tisya Goyal had undergone various medical treatments upto the year 2011 when the insurance cover was with M/s Royal Sundaram.  Even the copies of the medical records/papers have been filed on the record to substantiate this fact.

Policy in question was issued on 31.3.13.  Under Section 45 of the Insurance Act, the insurance company has a liberty to get the matter investigated in respect of concealment of facts etc. by the insured while obtaining the insurance policy.  Therefore, the OPs must have exercised the power under Section 45 of the Insurance Act and got the matter investigated whereupon it transpired to the OPs that the complainant while obtaining the policy in question from the OPs had concealed the material facts with regard to the already existing disease of his daughters.

          Therefore, we hold that the complainant has failed to make out a case of deficiency in service on the part of the OPs.  Accordingly, we dismiss the complaint with no order as to costs.

           Let a copy of this order be sent to the parties as per regulation 21 of the Consumer Protection Regulations.  Thereafter file be consigned to record room.

Announced on   23.03.2016.

(NAINA BAKSHI)                                                                                                                                                    (N.K. GOEL)  MEMBER                                                                                                                                                                 PRESIDENT   

Case No. 72/14

23.03.2016

Present –   None.

        Vide our separate order of even date pronounced, the complaint is dismissed.  Let the file be consigned to record room.

(NAINA BAKSHI)                                                                                                                                                    (N. K. GOEL)    MEMBER                                                                                                                                                                  PRESIDENT