Delhi

New Delhi

CC/37/2013

Ashish Gupta - Complainant(s)

Versus

M/S. United India 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./37/2013                                                                                                                                                                        Dated:   

In the matter of:

SHRI ASHISH GUPTA

R/o S-537, School Block,

Shakarpur,

New Delhi-110092

           ……….COMPLAINANT

 

VERSUS

       THE UNITED INDIA ASSURANCE CO.LTD.,

       H-61, 1^st Floor, Gobind Mansion,

       Indira Place, Behind Plaza Cinema,

       Connaught Place,

       New Delhi-110001.

 

 ….... OPPOSITE PARTY

 

ORDER

Member  :  RITU GARODIA

The short facts of complaint are that complaint purchased medical insurance from 2004 which was renewed annually and was renewed from 23/5/2012 to 22/5/2013 vide policy No. 041701/48/12/97/00000066.  He was admitted in Cosmos Hospital Pvt. Ltd.  on 8/10/2012.  Bills for Rs. 1,54,341/- is annexed with complaint.  The discharged summary shows Bipolar Affective Disorder Currently in Mania with Psychotic Feature.

The claim was repudiated by OP in letter dated 8/12/2012 under clause 4.6.

OP has reiterated the same in its version. OP has also admitted that this clause was not present in 2004 at the time of issuance of first policy.  It was added subsequently form 2007 onward as per IRDA guidelines.

We have perused the documents, policy annexed by complainant.  OP has filed the terms and conditions of policy.  OP has admitted that condition was incorporated in 2007.  However, OP has not placed on record any evidence regarding intimation to complainant as to the change in conditions.  A lay person takes the policy and goes through the agreement at the time of inception.  Any change in conditions and clauses in latter years has to be informed explicitly to insured.  He continues with the policy with full faith.  It is settled law that both parties are bound by principle of good faith.

We find that OP has committed deficiency is not informing the change in condition to complaint.  OP is therefore directed to settle the claim for Rs. 1,54,341/-with 9% interest from the date of claim till payment.  We also award Rs. 25,000/- compensation for harassment, caused due to negligence of OP, inclusive of litigation expenses.

 

 

(C.K.CHATURVEDI)

President

 

(RITU GARODIA)

Member