Delhi

New Delhi

CC/600/2012

Dr. D.K. Kapoor - Complainant(s)

Versus

M/S. Royal Sundaram Alliance Insurance Company Ltd. - Opp.Party(s)

26 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./600/12              Dated:

In the matter of:

Sh. R.K. Kapoor,

R/o. 27 B, MIG Flats,

SheikhSarai, Phase-I,

New Delhi

 

        ……..COMPLAINANT

 

VERSUS

Royal Sundaram Alliance Insurance

Co. Ltd.

1505-1506, 15^th Floor,

Ambadeep  Bldg.,

14, Kasturba Gandhi Marg,

Connaught Place,

New Delhi

 

Also at:

 

Sundaram Towers

45-46, Whites Road,

Chennai-600014.

               .... OPPOSITE PARTY

 

ORDER  

President: C.K. Chaturvedi

        The complainant had a Health Medisafe policy from OP for the period 6/8/2011 to 5/8/2011.  The policy was in existence since 2008, covering him and his family and members.  The complainant had a Suuden Headache and lost consciousness and ws taken to AIIMS.  He was treated for MC  Aneurysm Ailment and spent Rs. 5,11,583/- a treatment through sum insured was Rs. 1 lakh.  The OP on submission of claim, repudiated the claim on the basis of opinion of OP’s own doctors, because complainant was hypertensive for 20 years, which was a predisposing factor for the ailment, and was caused by HT.

        The OP in reply has reiterated the same ground, without placing on record the so called ‘opinion’ of its doctors.  We have considered the submission of both the sides and perused the record.  In our view, the OP has taken shelter behind a stock defence of Hypertension, without application of mind.  The complainant is a man of 54½ years of age, and it is settled law that ordinary hypertension unless earlier treated as a disease in hospital, is a normal part of modern life and is not ground for repudiating any claim of insurance arbitarily.   The OP has produced no such evidence of ‘opinion’ of the doctors nor its doctor clinically ever examined the complainant, nor it produced any evidence of hospital of complainant for treatment of HT.

        We hold OP deficiency in services, and direct it  to pay Rs. 1 lakh, the insured sum with 9% p.a. till the date repudiates the payment.  We also awarded Rs. 30,000/- as compensation and 10,000/- for litigation expanses.

        The order shall be complied within 30 days of the receipt of the copy of the order.

 

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

 

(C.K.CHATURVEDI)

President

 

 

(RITU GARODIA)

Member