Delhi

New Delhi

OC/1679/2003

Raj Kumar Bajaj - Complainant(s)

Versus

M/S. National Insurance Company Ltd. - Opp.Party(s)

30 Apr 2015

ORDER

CONSUMER DISPUTES REDRESSAL FORUM-VI

(DISTT. NEW DELHI), ‘M’ BLOCK, 1^STFLOOR,

VIKAS BHAWAN, I.P.ESTATE,

NEW DELHI-110002.

 

Case No.OC/1679/03                                                                                                                                                                              Dated:

In the matter of:

Mr. Raj Kumar Bajaj,

S/o Sh. J.P Bajaj,

R/o 53, Kohat Enclave,

Pitampura, Delhi-110088

……..COMPLAINANT

       

VERSUS

 

National Insurance Co. Ltd.,

D.O No.27, Gopal Dass Bhawan,

12th Floor, 28, Barakhamba Road,

New Delhi-110001

Regd. Office at:

3, Middleton Street, Kolkata

                         ………. OPPOSITE PARTY

 

ORDER

President:  C.K Chaturvedi

 

The complaint was filed in 2003, and it is unfortunate that matter has lingered so long. The perusal of the records shows that OP filed a formal reply on the matter, by taking a false plea of pre-existing hypertension of complainant, who had taken a medi claim policy in 1999, after a formal medical examination and continued the policy till 2002, when he was admitted in Escorts Heart Hospital for Coronary Artery Disease of blocked arteries. He took treatment and submitted bill to OP which did not reimburse and repudiated by saying that it was pre-existing, on the basis of its Dr. R.K Mahajan, who studied tests done in 1999 in Escorts before taking policy.

The complainant got summoned the medical examination done in 1999, at the time of taking policy. There is no other dispute in the case; the original record of Escorts Heart Hospital of complainant bearing no.EHIRC no.99-105626 of 11.11.99 is placed on record. Page 27 of the record is Heart Station Exercise ECG to show BP at beginning of exercise at 140/90, with exercise increased as per reports shows nil, and normal report of symptoms. The discharge summary of treatment in 2002 alone after 3years of policy records Hypertensive at that time. OP has no evidence of any such thing in 1999 and insured him.

We have considered the entire record and submission on record. The law norms are well settled that HT is not considered a pre-existing disease, nor is there any such in this case and discharge summary findings of diagnosis in 2002 is no grounds to repudiate the claim. There was no CAD in 1999, and all symptoms presented in 2002.

In our considered view, OP has totally misdirected itself on S.45 of the Insurance Act, which is also a complete bar to such challenge, as rightly submitted by complaint’s counsel in submissions. The OP has harassed the complaint to the hilt by opposing claim for last 12 years on false basis.

We direct OP to pay the insured sum of Rs.2 lakhs with interest of 9% from 90^th day of claim with OP, and pay Rs.1 lakhs for deficiency, harassment and litigation expenses in last 12 years.

        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.

File be consigned to record room.

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

 

 

Pronounced in open Court on 30.04.2015.

 

(C.K.CHATURVEDI)

PRESIDENT

 

 

(S.R. CHAUDHARY)                 (Ritu Garodia)

MEMBER                                  MEMBER