Date of filing:  13.01.2021                                                     Date of Disposal: 31.03.2023

 BEFORE THE III ADDITIONAL BANGALORE URBAN

DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION,

                               BENGALURU – 560 027.

DATED THIS THE 31^st DAY OF MARCH, 2023

CONSUMER COMPLAINT NO. 40/2021

PRESENT:

SRI.RAJU K.S,

SMT.REKHA SAYANNAVAR,:MEMBER

Samiulla Khan,

Aged About 66 Years,

No.8, Samitha Enclave,

A1 1^st Floor, Stephen’s Road,

Frazer Town, Bangalore-560005.

Max Bupa Health Insurance Company

Limited, B-1/1-2, Mohan Cooperative

Industrial Estate Mathura Road,

New Delhi South DL-110044.

Rep. by General Manager Claims.

//JUDGEMENT//

BY SRI. RAJU K.S, MEMBER

01.    The complainant has filed this complaint seeking for a direction to the opposite party to pay Rs.3,20,000/- with Rs.20,00,000/- as compensation.

02.    The case of the complainant is that, the complainant availed health insurance from the opposite party for himself and his wife Gulnaz Khan Under Policy No.30965063202001.  The opposite party has refused to pay the claim amount of Rs.3,20,000/- by saying that, the complainant has suppressed the material fact that, the complainant’s wife was suffering from pre-existing illness, medical conditions, hypertension, diabetes mellitus, hyperthyroidism, since 05 to 06 years before the date of inception of the policy.  One Santhosh Hospital, Bangalore had refused cashless treatment to wife of the complainant on 15.07.2020 by saying the insurance company has refused to honour cashless treatment and claim has to be made subsequently after payment, to the opposite party insurance company.

03.    The act of the opposite party insurance company in refusing claim of the complainant with regard to treatment took by the complainant’s wife for Rs.3,20,000/- is amounts to deficiency of service.  The opposite party practicing unfair trade practice in order to dupe the hard earned money of complainant.  In-spite of serving the legal notice the opposite party has refused to honour the claim of the complainant intentionally which amounts to mental agony to the complainant.  Hence there is no other way to the complainant to approach this Commission and pray for allow the complaint as sought.

04.    Based on the pleadings and documents the points that would arise for consideration are as under:-

  (1) Whether the complainant has proved deficiency in service on the part of the opposite party in refuse of claim of the complainant?

  (2) Whether the complainant are entitle for the 

    relief as sought ?

       (3) What order ?

05.    Our findings on the aforesaid points are as follows:-

Point No.1 :  In negative

Point No.2 :  In negative

Point No.3 :  As per the final order for the following:-

REASONS

06. POINT NO.1 & 2:-  To avoid the repetition of facts of the complaint we have discussed point No.1 & 2 together.  The complainant has filed this complaint for the alleged deficiency of service and unfair trade practice by the opposite party.  The main allegation of the complainant is that, the opposite party dishonoured claim of the complainant in-spite of repeated request and notice.  As per the document filed by the complainant letter dated: 15.09.20 issued by the opposite party specifically states that, the claim under policy No.30965063202001 was repudiated due to the complainant not disclosed the pre-existing illness of his wife Smt. Gulnaz Khan who was suffering from Hypertension/Diabetes mellitus / hyperthyroidism since 5 to 6 years.  Further in the above letter the opposite party stated that, as per clause-3 of policy terms and conditions they have cancelled the policy with issuing 30 days notice. 

07.    On perusal of the order-sheet it appears that, the notice issued to the opposite party on 05.02.2021 is returned with shara “Left”.  Thereafter from 24.03.2021 till 30.03.2023 when the case was posted to orders the complainant remained absent and not chosen to take appropriate steps against opposite party for serving of Commission notice.  This act of the complainant clearly shows the lackadaisical nature.  Further to substantiate the complaint’s averments the complainant has not filed his affidavit evidence and documentary evidence as contemplated under Section 38(6) of Consumer Protection Act, 2019.  Since from 19.01.2021 from the date of filing the complaint, the complainant neither appeared nor filed his affidavit in the form of his evidence.

08.    Section 38(9) of Consumer Protection Act, 2019 envisages that, “the District Commission shall have the same powers as are vested in a Civil Court under the Code of Civil Procedure, while trying a suit in respect of receiving of evidence on affidavits.”   The complainant shall tender the sworn affidavit evidence by entering in to witness box.  Same has not been followed by the complainant in the present complaint.  The complainant had failed to prove the burden casted on him.  In view of the above, the complainant has failed to prove the deficiency of service on the part of the opposite party as alleged.  Accordingly we answer point No.1 & 2 in negative.

09.    POINT NO.3:-     As discussed supra, for the foregoing reasons we proceed to pass the following:-

ORDER

The complaint is dismissed.  No order as to costs.

Supply free copy of this order to both the parties and return extra copies of the pleading and evidence to the parties.

Applications pending, if any, stands disposed-off in terms of the aforesaid judgment.

(Dictated to the Stenographer, typed by him, the transcript corrected, revised and then pronounced in the open Commission on 31^st Day of March, 2023)                                            

• REKHA SAYANNAVAR)    (RAJU K.S)         (SHIVARAMA. K)    
•  

//ANNEXURE//

Witness examined for the complainant side:

• NIL -

Documents marked for the complainants side:

• NIL -

Witness examined for the opposite party side:   

• NIL –

Documents marked for the Opposite Party side:

• NIL -

• REKHA SAYANNAVAR)    (RAJU K.S)         (SHIVARAMA. K)    
•