ORAL ORDER
Per Hon’ble Mr.S.R.Khanzode, Presiding Judicial Member
This appeal takes an exception to an order dated 29/08/2012 passed in consumer complaint no.73/2010, Mr.Kedar Vijaykumar Shete v/s. New India Assurance Co.Ltd. and another; by District Consumer Disputes Redressal Forum, Pune. Undisputed facts are that mediclaim policy was taken by the respondent/complainant - Mr.Kedar Vijaykumar Shete (herein after referred as ‘complainant’) on 27/11/2004. Thereafter, said policy was renewed from time to time and, lastly, renewed for the period from 19/12/2008 to midnight of 18/12/2009. The insurance claim is pertaining to the hospitalization for the period 21/10/2009 to 28/10/2009 and it stood rejected by the Insurance Company on the ground that the hospitalization was only for the investigation purpose.
Forum considering the material placed on record, awarded the claim and directed Insurance Company to pay `1,50,000/- i.e. an amount permissible under the insurance policy as covered by the risk along with interest @ 9% interest p.a. w.e.f.21/11/2009 Further, Insurance Company was directed to pay costs of `2000/-. Being aggrieved thereby Insurance Company has preferred this appeal.
Heard Mrs.Kalpana Trivedi-Advocate for the appellant and Mr.U.B.Wavikar-Advocate for the respondent.
The only point raised on behalf of the appellant/Insurance Company is that the policy in question, since there was a break earlier, is a fresh policy and not a renewed policy and, therefore, clause 4.1 is duly attracted and in its first year, no claim could be awarded. We are afraid, Insurance Company cannot go beyond their own policy document which clearly mentions the date of issuance of first policy as “27/11/2004” and policy in question, “Previous Mediclaim Policy Number (Renewed) : 1534003407200004747”. Therefore, undoubtedly, the document of the insurance policy speaks for its status as a renewed policy. The claim arose in the sixth year of the policy and, therefore, 100% admissible claim or sum insured as stated for the individual is payable and, accordingly, forum has directed the amount of compensation to be paid.
Submission that the claim is not admissible since only for the purpose of investigation the complainant got admitted in the hospital is also devoid of any substance. He took the admission for getting operated as per the medical advice and only when the cashless facility was not extended to him as per the policy by the Insurance Company, he was required to take a discharge abandoning further treatment.
We find no reason to take a different view than what has been taken by the forum. Thus, finding the appeal devoid of any substance, we pass the following order:-
ORDER
Appeal stands dismissed.
Appellant to bear their own costs and pay `25,000/- as costs to the respondent.
Pronounced on 6th February, 2013.
