Haryana

StateCommission

A/284/2016

BIRLA SUN LIFE INSURANCE CO. LTD. - Complainant(s)

Versus

NAVAL KISHORE GUPTA - Opp.Party(s)

S.C.THATAI

26 Oct 2016

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                 

First Appeal No  :    284 of 2016

Date of Institution:    05.04.2016

Date of Decision :     26.10.2016

 

1.     Birla Sun Life Insurance Company Limited, BSLT City Heard Building near Old Court Road, Narnaul through Ms. Aakriti Manocha, Assistant Manager-Legal.

2.     Managing Director, Registered Office Birla Sun Life Insurance Company Limited, One Indiabulls Centre Tower 1,15 & 16^th Floor, Jupiter Mill Compound, 841, Senapati bapat Marg, Elphinstone Road, Mumbai-400013.  

                                      Appellants-Opposite Parties

Versus

 

Naval Kishor Gupta s/o Shri Nand Kishor Gupta, Resident of Mohalla Kharkhari Narnaul, Tehsil Narnaul, District Mahendergarh.

 

                                      Respondent-Complainant

 

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

                             Shri B.M. Bedi, Judicial Member.

                             Shri Diwan Singh Chauhan, Member                                                                                                                                         

Argued by:          Shri S.C. Thatai, Advocate for appellants.

Shri Anoop Kumar Yadav, Advocate proxy on behalf of Shri C.S. Singhal, Advocate for respondent. 

 

                                                   O R D E R

 

B.M. BEDI, JUDICIAL MEMBER

 

          This Opposite Parties’ appeal is directed against the order dated December 7^th, 2015 passed by District Consumer Disputes Redressal Forum, Narnaul (for short ‘the District Forum’) whereby complaint filed by Naval Kishor Gupta-complainant/respondent, was accepted. For facilitation, the operative part of the order is reproduced as under:-

“Hence, the complaint of the complainant is hereby allowed with costs and the opposite parties are directed:-

1.    To refund the amount deposited by the complainant along with interest at the rate of 10% per annum from the date of filing of the present complaint till realization.
2. To pay Rs.2200/- as litigation charges to the complainant.”

2.               Naval Kishore-complainant/respondent purchased Medical Health Policy (Exhibit C-3) from Birla Sun Life Insurance Company Limited (for short ‘the Insurance Company’)-Opposite Parties, for Rs.5.00 lacs vide Proposal Form dated 6^th February, 2010 (Exhibit RB).  The next premium was payable on 19^th February, 2011 and the insured was liable to pay the premium within 30 days grace period. The policy lapsed on 19^th March, 2011 for non-payment of premium, however it was got revived on 28^th March, 2011 by making payment of the due premium. The insured fell sick and was hospitalized in Ahuja Hospital, Narnaul from 31^st May, 2011 to June 7^th, 2011. Claim being filed was not paid by the Insurance Company, hence the complainant filed the instant complaint before the District Forum.

3.                The Insurance Company-opposite parties contested the complaint by filing written version. It was stated that that the insured-complainant did not submit the required documents for revival of the policy and for that reason the policy could not be revived. So, the complainant was not entitled for the benefits of insurance. It was prayed that the complaint be dismissed.

4.                After evaluating the pleadings and evidence of the parties, the District Forum allowed complaint and issued direction to the opposite parties as detailed in paragraph No.1 of this order.

5.      `        While assailing the order of the District Forum, learned counsel for the appellants-Insurance Company referred to the relevant clauses of the policy which read as under:-

“Premium Discontinuous:

If you are unable to pay the policy premium by the due date, you will be given a grace period of 30 days during which time all insurance under the policy will continue.”

 

“Exclusions:

 

“No Health Insurance Benefit shall be payable by us at any time for any claim in/directly caused by, based on arising out of or howsoever attributable to any of the following:

• Any sickness related condition manifesting itself within 90 days from the policy issue date or effective date of revival, whichever is later. Only claims in respect of injuries caused by accident will be payable during these 90 days.”

6.                Learned counsel for the appellants-Insurance Company contended that in the event of fresh policy or revival, the Insurance Company was not liable for any sickness arising within 90 days.

7.                Undisputedly, the policy lapsed on 19^th March, 2011 and was revived on 28^th March, 2011. Treatment pertains to the period 31^st May, 2011 to 7^th June, 2011. In view of clauses of the policy reproduced above, the period of sickness for which reimbursement is sought, being within 90 days of the revival of the policy, the Insurance Company was not liable to reimburse any compensation to the complainant. The District Forum fell in error in allowing the complaint and as such the impugned order cannot be allowed to sustain.

8.                In view of the above, the appeal is allowed, the impugned order is set aside and the complaint is dismissed.

9.                The statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the opposite parties-appellants against proper receipt and identification in accordance with rules, after the expiry of period of appeal/revision, if any.

 

Announced 26.10.2016

Diwan Singh Chauhan Member

B.M. Bedi Judicial Member

Nawab Singh President

CL