Delhi

New Delhi

CC/1118/2010

Pramod Kumar Singh - Complainant(s)

Versus

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

29 May 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/1118/10                                                                                                                                                                              Dated:

In the matter of:

Pramod Kumar Singh,

S/o late Bhola Sing,

264, 1^st Floor, Sector-30-33, I.P Colony,

Faridabad, Haryana.

……..COMPLAINANT

       

VERSUS

 

United India Insurance Co. Ltd.,

8^th Floor, Kanchanjunga Building,

17, Barakhamba Road, New Delhi-110001

 

                         ………. OPPOSITE PARTY

 

ORDER

President:  C.K Chaturvedi

 

        The deficiency alleged in the complaint is repudiation of medi claim of treatment of father of complainant for heart ailment after taking the medi claim policy of Rs.2 lakhs. It is alleged that complainant had a policy w.e.f. 19.11.09 to 18.11.10. It is alleged that in Jan 2010 he fell ill and admitted in Fortis Escorts hospital, Faridabad from 31.01.10 to 04.02.10. The claim was rejected on the ground that his father was suffering from a pre-existing disease (Cholangio Carcinoma). He was again hospitalized from 12/13.05.10 and died. The hospital raised bill of Rs.47,550/- which was again rejected on grounds of pre-existing disease.

        It is alleged by complainant that his father was medically examined before issuing policy, and before treatment he had no such knows disease, and first time he came to know when he fell ill.

        The OP has produced in reply enclosing no evidence to the effect that the insured had taken any hospitalization or diagnoses before the taking of policy.

        We have considered the submissions of the parties, reply & evidence and case law. It is well settled (See 2008 ACJ 2399 (SC), 1 (2008) CPJ 501 NC, AIR 2008 Delhi 29 (SC) 2008 CPJ) that the pre-existing disease should be supported by the claimer before taking the policy. Complainant suffered of the same after inception of policy has no effect. The burden is always on the insurer to show that there was concealment of facts. The opinion of TPA that disease was pre-existing; in itself has no weight without evidence in that effect.

        In the view of this legal position, we hold the repudiation of claim as arbitrary and illegal and OP has committed deficiency in service. We direct OP to pay the sum of Rs.2 lakhs against the bills of more than 2 lakhs. OP will also pay Rs.50,000/- for deficiency, harassment and 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.

File be consigned to record room.

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

 

 

Pronounced in open Court on 29.05.2015.

 

(C.K.CHATURVEDI)

PRESIDENT

 

 

(S.R. CHAUDHARY)

MEMBER