Haryana

StateCommission

A/425/2017

HDFC ERGO GEN.INSURANCE CO. - Complainant(s)

Versus

POONAM MANGLA - Opp.Party(s)

PRADEEP KUMAR

12 Jul 2017

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION HARYANA, PANCHKULA

         

                                       

First Appeal No  :       425 of 2017

Date of Institution:      10.04.2017

Date of Decision :      12.07.2017

 

HDFC ERGO General Insurance Company Limited, Steller I.T. Park, Tower 1, 5^th Floor, C-25, Sector 62, Noida-201301, through Managing Director, through its authorized officer.

                             Appellant-Opposite Party No.1

 

Versus

1.      Smt. Poonam Mangla wife of Sh. Rakesh Mangla, resident of Moti Kiran Vatika, Dharma Nagar, Palwal, Tehsil and District Palwal.

Respondent-Complainant

2.      HDFC Bank, Maharishi Dayanand Chowk (Agra Chowk), Palwal through Manager.

Respondent-Opposite Party No.2

 

 

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

                             Shri Balbir Singh, Judicial Member.

                                                                                                                            

Argued by:          Shri Pradeep Kumar, Advocate for appellant.

                             Shri Gaurav Gupta, Advocate for respondent No.1-complainant.

                             (Service of respondent No.2 dispensed with vide order dated June 23^rd, 2017)

 

                                                   O R D E R

 

 

NAWAB SINGH J.

 

The instant appeal filed by HDFC ERGO General Insurance Company Limited-opposite party No.1 (for short, ‘Insurance Company’) calls in question the correctness of the order dated February 16^th, 2017 passed by District Consumer Disputes Redressal Forum, Palwal (for short ‘the District Forum’) whereby complaint filed by Poonam Mangla-complainant was allowed.  For facilitation, operative part of the order is reproduced as under:-

“Accordingly, the complaint is hereby allowed with the directions to opposite party No.1 to pay Rs.75,000/- in toto which has been spent by the complainant on her treatment and lab tests as well as Rs.10,000/- as compensation for mental tension, agony and harassment as well as Rs.5500/- as litigation expenses.  All the above directions are to be complied within 45 days from the receipt of the copy of this order failing which the opposite party No.1 will be further burdened to the tune of Rs.10,000/- alongwith the above awarded amount…”

 

2.      The complainant purchased Health Suraksha Policy (Annexure C-1) from the Insurance Company.  The period of insurance was July 01^st, 2016 to June 30^th, 2018. The sum insured was Rs.3,00,000/-. The complainant took treatment of Chikungunya from Apollo Hospital, New Delhi from September 09^th to September 13^th, 2016.  She spent Rs.75,598/- on her treatment. The complainant submitted claim with the Insurance Company.  The Insurance Company repudiated the claim on the sole ground that the complainant was a known case of solitary kidney before the first inception of the policy and she did not disclose this fact while the purchasing the policy. Aggrieved thereof, the complainant filed complaint under Section 12 of the Consumer Protection Act, 1986. 

3.      The complainant purchased Health Suraksha Policy from the Insurance Company.  During the subsistence of the insurance policy, the complainant fell ill and took treatment of Chikungunya from Apollo Hospital, New Delhi from September 09^th to September 13^th, 2016.  The claim was repudiated by the Insurance Company only on the ground that the complainant was having solitary kidney, which she did not disclose at the time of purchasing the insurance policy.  The complainant purchased the insurance policy in order to cover medical expenses for any medically necessary treatment.  Solitary kidney is not a disease and is not life threatening.  Most people with one functional kidney continue to lead normal and healthy lives.  It does not affect the quality of life, although it becomes more important to maintain a healthy lifestyle.  When the complainant purchased the insurance policy, she was healthy.  She neither had any illnesses nor disorders. She donated her kidney in the year 2009. The complainant fell ill on September 09^th, 2016 on account of Chikungunya and not because she was having solitary kidney.  There is no nexus between solitary kidney and Chikungunya.  One needs to see the merits and good spirit of the clause, without compromising on bad claims. Rejection of claims on purely procedural grounds in a mechanical fashion will result in policy holders losing confidence in the insurance industry, giving rise to excessive litigation.  Thus, the impugned order passed by the District Forum is perfectly right and requires no interference. Accordingly, the appeal is dismissed.

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

 

Announced 12.07.2017

(Balbir Singh) Judicial Member

(Nawab Singh) President

UK