Delhi

New Delhi

CC/185/2013

Kunti Devi Gupta - Complainant(s)

Versus

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

06 Aug 2015

ORDER

CONSUMER DISPUTES REDRESSAL FORUM-VI

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

VIKAS BHAWAN, I.P.ESTATE,

NEW DELHI-110002.

 

Case No.CC/185/13                                                                                                                                                                               Dated:

In the matter of:

Smt. Kunti Devi Gupta,

W/o Late Sh. Hari Shankar Gupta,

C/o Balaji Stationers, GF 26-A, Antriksh Bhawan,

22, K.G Marg, New Delhi

……..COMPLAINANTS

       

VERSUS

1. Royal Sundaram Alliance Insurance Co. Ltd.,

        Through the Manager,

        15^th Floor, 1505 Ambadeep Building,

        14, K.G Marg, New Delhi-110001

 

2. Citi Bank N.A,

        3^rd Floor, Jeevan Bharti Building,

        Parliament Street, New Delhi-110001

 

3. Royal Sundaram Alliance Insurance Co. Ltd.,

        21, Patullos Road, Chennai-600002

 

4. Royal Sundaram Alliance Insurance Co. Ltd.,

        Corporate Accident & Health Claims      Department, Deshbandu Plaza, GF, no.47,         Whites Road, Chennai-600014

 

                                         ……. OPPOSITE PARTIES

 

 

 

 

ORDER (Oral)

Date of Arguments: 06.08.2015

Member: Ritu Garodia

Present:    Both the Parties.

                Arguments heard at length.

 

The Complaint pertains to repudiation of medi claim by OP1. The Complainant purchased a Health Forever Policy no.HCF0000072000100 from 01.08.12 to 31.05.12. The sum insured was of Rs.2,00,000/- and is admitted by OP. Both parties accept that complainant suffer Ischemic Stroke and was hospitalized in Max Super Special Hospital on 04.08.12 and discharged on 10.08.12. Hospital bills for Rs.1,25,499.89/- have been annexed. OP repudiated the claim on the grounds of exclusion under pre-existing disease. The disease elucidated is hypertension.

Perusal of pleading reveals that a subsequent claim by complainant for which she was hospitalized on 20.09.12 was duly paid by OP1. It is well settled that hypertension and diabetes are malaise of normal life style unless there has been serious hospitalization regarding the same.

Complainant has also relied on an order of Hon’ble High Court in “Hari Om Agarwal Vs. OIC”, 2007(98) DRJ 246 wherein it is stated that “it would be apparent that the object of the insurance policy is to cater to medical expenses incurred by the insured. That is the “main purpose of the contract of insurance.”

OP cannot repudiate the claim on flimsy ground of hypertension to overcome the main object of medical insurance. OP had subsequently settled another claim by some complaint without taking any protest of pre-existing disease. It has become a standard practice of insurance company to deny medical claim on frivolous and unsubstantiated grounds.

OP is therefore guilty of not paying the claim and is directed to pay Rs.1,25,499.89/- with interest of 9% from date of claim till encashment. We also award Rs.50,000/- as compensation for harassment and inconveniences and Rs.10,000/- as litigation expenses.

The order shall be complied with within 30 days of the receipt of the copy of the order; otherwise action can be taken against OP 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 06.08.2015.

 

 

 

(C.K.CHATURVEDI)

PRESIDENT

 

 

 (Ritu Garodia)

MEMBER