Haryana

StateCommission

A/788/2016

ICICI PRU.LIFE INSURANCE CO. - Complainant(s)

Versus

NARENDER SINGH SAHARAN - Opp.Party(s)

HITENDER KANSAL

08 Mar 2017

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

         

                                       

First Appeal No  : 788 of 2016

Date of Institution: 31.08.2016

Date of Decision : 08.03.2017

 

1.      M/s ICICI Prudential Life Insurance Company Limited, ICICI Prulife Towers, 1089, Appasaheb Marathe Marg, Prabha Devi, Mumbai 400025 through its President/Principal Officer.

2.      M/s ICICI Prudential Life Insurance Company Limited, 3^rd Floor, Ashoka Plaza Opposite Myna Tourist Complex, Delhi Road, Rohtak-124 001 through its Divisional Manager.

                                      Appellants-Opposite Parties

Versus

 

Narender Singh Saharan, resident of House No.13, Near Double Phatak, Old Housing Board Colony, Rohtak.

Respondent-Complainant

 

 

CORAM:             Hon’ble Mr. Justice Nawab Singh, President.

                             Shri Balbir Singh, Judicial Member.

 

 

Argued by:          Sh. Hitender Kansal, Advocate for the appellants.

                             Sh. Ravinder Malik, Advocate for the respondent

 

 

                                                   O R D E R

 

 

NAWAB SINGH J, (ORAL)

 

          By filing the present appeal, ICICI Prudential Life Insurance Company Limited and its functionary-opposite parties (for short, ‘Insurance Company’) have challenged the order dated June 01^st, 2016 passed by District Consumer Disputes Redressal Forum, Rohtak (for short, ‘District Forum’) complaint filed by Narender Singh-complainant was allowed.  The Insurance Company was directed to pay Rs.1,50,000/- alongwith interest at the rate of 9% per annum from the date of filing the complaint, that is, January 23^rd, 2009 till its realization and Rs.3500/- litigation expenses to the complainant on account of ailment. 

2.      The complainant purchased Health Assure Policy from the Insurance Company.  The date of commencement of the policy was April 27^th, 2007.  The maturity/termination date was April 27^th, 2022.  The complainant fell ill and was admitted in PGIMS, Rohtak on October 17^th, 2007.  He was diagnosed as a case of Ischemic Heart Disease.  He spent Rs.1,50,000/- on his treatment.  He filed claim with the Insurance Company but the same was repudiated on the ground that the complainant was not covered under Sub Clause iv of Clause 1 of the policy because he was suffering from critical illness-heart attack as mentioned in Clause 2 of the insurance policy.  The complainant fell sick within six months from the date of commencement of the policy, that is, April 27^th, 2007. 

3.      Learned counsel for the parties have been heard and record over the file has been perused. 

4.      Clause 2.2 of insurance policy reads as under:-

          “2.2  The benefit shall not apply or be payable in respect of any critical illness of which the symptoms have occurred or for which care, treatment, advice was recommended by or received from a Physician, or which first manifested itself or was contracted before the issue date of the policy or during the first six months from the policy issue date or for which a claim has or could have been made under any earlier policy.”  

 

5.      Heart Attack (Myocardial Infarction) falls under Clause 2 –Critical Illness.  The date of commencement of the policy was April 27^th, 2007 and the complainant was admitted in PGIMS, Rohtak on October 17^th, 2007, that is, during the first six months from date of issue of the policy.  As per clause 2.2, the benefit shall not be paid in respect of any critical illness of which the symptoms have occurred or for which care, treatment or advance was recommended by or received from a Physician for which first manifested itself or was contracted before the issue date of the policy.  It is not in dispute that the complainant was a patient of Ischemic Heart Disease and was admitted in PGIMS, Rohtak within six months from the date of commencement of the policy.  So, the complainant was not entitled for the benefits of insurance. The District Forum fell in error in allowing the complaint.  

6.      For the reasons recorded supra, the appeal is accepted, impugned order is set aside and the complaint is dismissed. 

7.      The statutory amount of Rs. 25000/- deposited at the time of filing the appeal be refunded to the appellants against proper receipt and identification in accordance with rules.

 

Announced 08.03.2017

(Balbir Singh) Judicial Member

(Nawab Singh) President

UK