Delhi

New Delhi

CC/272/2012

Mohd. Mustafa - Complainant(s)

Versus

M/S. Apollo Munich Health Insurance Company Ltd. - Opp.Party(s)

27 Nov 2015

ORDER

CONSUMER DISPUTES REDRESSAL FORUM-VI

(DISTT. NEW DELHI),

 ‘M’ BLOCK, 1^STFLOOR, VIKAS BHAWAN, I.P.ESTATE, NEW DELHI-110001.

 

Case No.C.C./272/2012                                                                                                                                                               Dated:   

In the matter of:

Mohd. Mustafa

R/o A-9, Block A,

Sangam Vihar,

New Delhi-110062

                                            ……….COMPLAINANT

 

VERSUS

1.     Apollo Munich Health

        Insurance Co. Ltd.,

        10^th Floor, Tower-B,

        Building No. 10,

        DLF Cyber City,

        Phase-II, Gurgaon,

        Haryana-122002.

 

2.     Branch Office,

        Apollo Munich Health,

        Insurance Co. Ltd.,

        2/2-A, 1^st Floor,

        Universal Insurance Bldg.,

        Asaf Ali Road,

        New Delhi-110002.

 

 

   ….... OPPOSITE PARTIES

ORDER

Member  :  RITU GARODIA

The complaint pertains to repudiation of mediclaim.

        The complainant purchased ‘Easy Health Plan’ from OP which was renewed vide policy No. 110100/11002/1000092549 till 24/04/2011.  The complainant was hospitalized from 17/10/2011 to 22/10/2011 and incurred expenses upto Rs. 60,627/-.  The hospital bills are annexed with the complaint. The complainant filed his claim which was repudiated by OP on the grounds that hospitalized period was not covered under the claim.

      OP in its reply has alleged that complainant was Bidi Smoker and suffering from diabetes which had been suppressed in proposal form.  Thereafter,  OPs on receiving cashless claim and going through the IPD papers cancelled the insurance policy.  OP further contests that as the hospitalization was after the cancellation it was well within its right to repudiate the claim.

Arguments were heard. The complainant was present in person and stated that he is in economically challenged person and was induced and allured by OP marketing agents in taking the policy.  His sons took him the private hospital instead of govt. hospital as he had medical insurance which could be reimbursed.

Perusal of the proposal form filled by Insurance Company reveals that the complainant has signed in vernacular though the said proposal form has been filled in English by the agent of OP.  The complainant states that he has no idea to what was filled in the proposal form.  The OPs on receiving the cashless claim by the complainant cancel the insurance with the malafide intention of denying the rightful claim.  It is seen that it is a regular practice of the marketing agents of insurance company to dupe illiterate and uneducated people.  OP instead of investigating the agent who had filled the form cancelled the policy and repudiated the claim.

We, therefore, hold OP guilty of indulging in ‘Unfair Trade Practice’ in cancellation of policy and subsequently denying the claim.  We directed to pay Rs. 60,627/- with 9% interest from the date of claim till hospitalization.  We also awarded Rs.30,000/- as compensation for harassment financial difficulties, cause to the hapless consumer.  We also awarded Rs. 10,000/-  as litigation expenses.

The order shall be complied within 30 days of the receipt of the copy of the order; otherwise action can be taken under Section 25 / 27 of the Consumer Protection Act.

Copy of the order be sent to the parties free of cost.

File be consigned to record room.

 

(C.K.CHATURVEDI)

President

 

 

(RITU GARODIA)

Member