Haryana

StateCommission

A/870/2016

STAR HEALTH AND ALLIED INSURANCE CO.LTD. - Complainant(s)

Versus

PARKASHO DEVI - Opp.Party(s)

NITESH SINGHI

08 Mar 2018

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

                                                 

First Appeal No.    870 of 2016

Date of Institution:  26.09.2016

Date of Decision:   08.03.2018

 

1.      Star Health and Allied Insurance Company Limited, through its Branch Manager/Authorized Officer, CUE 273, 1^st Floor, Green Square Market, Opposite Aggarsain Bhawan, Hisar.

 

2.      Branch Manager, Star Health and Allied Insurance Company Limited, City Centre, IInd Floor, GT Road, Above Reliance General Insurance, Panipat-132103.

 

…..Appellants-Opposite Parties No.1 and 2

 

Versus

 

1.      Parkasho Devi wife of late Shri Bal Krishan Jain, aged 61 years, resident of House No.177/10, Kille Wali Gali, Hansi, Tehsil Hansi, District Hisar.

 

……Respondent No.1-Complainant

 

2.      Ms. Yogita Singhal, Intermediary Code-BA0000089459, Particulars shall be disclosed by respondents No.1 and 2.

 

……Respondent No.2-Opposite Party No.3

 

 

CORAM:   Mr. R.K. Bishnoi, Judicial Member.

                   Mrs. Urvashi Agnihotri, Member.

                  

   

 

Present:     Shri Nitesh Singhi, counsel for the appellants.

                   Shri R.K. Narang, counsel for the respondent No.1.        

                   None for the respondent No.2 (Ex parte before the District Forum).

 

                            

O R D E R

 

R.K. BISHNOI, JUDICIAL MEMBER

 

          It was alleged by complainant-respondent No.1 that her husband Bal Kishan Jain obtained Senior Citizens Red Carpet Insurance Policy (Exhibit R-1) on 20.12.2010 valid upto midnight of 19.12.2011 covering all health risks. On 05.10.2011 her husband developed some problem and was taken to Sarvodaya Multispeciality Hospital, Hisar, where infarct left cerebral right hemiplegia was detected. Information was immediately given to opposite party (in short ‘OP’) No.1 i.e. Star Health and Allied Insurance Company Limited, but, no help qua advance cashless treatment was provided. Her husband remained admitted in hospital till 18.10.2011 and in the morning of 19.10.2011 he breathed his last. Rs.1,61,452/- were spent on his treatment. Claim submitted with Insurance Company was repudiated on the ground of concealment of previous ailment and misrepresentation at the time of obtaining aforesaid policy.  

2.      In reply, it was alleged that husband of complainant was diagnosed for the ailments of Ischaemic Heart Disease (HID), Diabetes Mellitus (DM), Chronic Obstructive Pulmonary Disease (COPD) since two years. But when the policy was obtained on 20.12.2010, this fact was not disclosed, so, claim of complainant was rightly repudiated.

3.      After hearing both the parties, learned District Consumer Disputes Redressal Forum, Hisar (in short ‘District Forum’) disbelieved the version of Insurance Company on the ground that photocopy of discharge card was not admissible and allowed the complaint vide impugned order dated 15.07.2016.

4.      Feeling aggrieved therefrom, OPs No.1 and 2 have preferred this appeal.

5.      Arguments heard. File perused.

6.      Learned counsel for the complainant-respondent No.1 vehemently argued that Insurance Company produced photocopies (Exhibits R-3 and R4) pertaining to Dr. Ranjit Singh Saini but did not examine him, so, learned District Forum rightly disbelieved that version. Findings of learned District Forum are well reasoned, based on law and facts and appeal be dismissed.

7.      This argument is devoid of any force. It is well settled proposition of law that Evidence Act is not strictly applicable in the proceedings initiated under Consumer Protection Act, 1986 (in short ‘Act’). Even photocopies of treatment record can be looked into. These documents were not brought to the notice of complainant for the first time during evidence, but were mentioned in reply of complaint. It was also mentioned in repudiation letter that her husband concealed the fact of previous ailment and that is why claim was repudiated. As per Exhibit R-3 dated 22.11.2010 and Exhibit R-4 dated 12.12.2010 respectively husband of complainant went to Dr. Ranjit Singh Saini and was having the problem as mentioned above. Treatment given to him is also mentioned therein. This fact is also mentioned in discharge summary (Exhibit R-7 and R-8) of Sarvodaya Multispeciality Hospital, Hisar. The husband of complainant has taken treatment from this very hospital and she cannot back out from them. It is no where alleged by complainant that her husband did not get treatment at the hospital of Dr. Ranjit Singh Saini and this record was not correct. After filing written version she tendered her affidavit (Exhibit C-53) in evidence, but, did not utter even a single word regarding this concealment. In proposal form, attached with Insurance Policy (Exhibit R-1), it was specifically alleged that her husband was not suffering from any problem. When deceased life insured concealed this fact, she cannot ask for any compensation. These views are also fortified by opinion of Hon’ble National Consumer Disputes Redressal Commission expressed in Revision Petition No.3201 of 2007 titled as “LIC of India & Ors. Versus N.P. Nagarathna, decided on 14.03.2012 and Hon’ble Punjab State Consumer Disputes Redressal Commission expressed in First Appeal No.332 of 2004 titled as “Sangeeta Kaushik and others Versus Life Insurance Corporation of India and others” decided on 17.11.2009 (cases laws cited by counsel for appellants). Learned District Forum failed to consider this fact, so, Impugned order dated 15.07.2016 cannot be sustained and is hereby set aside. Resultantly, the appeal is allowed and complaint is dismissed.

8.      The statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the appellants against proper receipt and identification in accordance with rules.  

 

Announced 08.03.2018

(Urvashi Agnihotri) Member, Addl. Bench

(R.K. Bishnoi) Judicial Member, Addl. Bench

D.R.