Date of Filing: 22.01.2010<br /> Date of Order: 04.11.2010<br /> <br /> 2<br /> <br /> BEFORE THE II ADDITIONAL DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, SESHADRIPURAM BANGALORE-20<br /> <br /> Dated: 04TH DAY OF NOVEMBER 2010<br /> <br /> PRESENT<br /> <br /> <br /> <br /> Sri S.S. NAGARALE, B.A, LL.B. (SPL.), President.<br /> Smt. D. LEELAVATHI, M.A.LL.B, Member.<br /> Sri BALAKRISHNA. V. MASALI, B.A, LL.B. (SPL.), Member.<br /> COMPLAINT NO: 137 OF 2010<br /> Nanda Gopal Poddar<br /> S/o. Late S.R. Poddar<br /> # 408, VARS All Seasons<br /> Syndicate Bank Cross<br /> Off. Airport Road, Konena Agrahara<br /> Bangalore 560 017 Complainant<br /> V/S<br /> 1. Royal Sundaram Alliance<br /> Insurance Co. Ltd.<br /> No. 46, Whites Road<br /> Chennai 600 014<br /> <br /> 2. Royal Sundaram Alliance<br /> Insurance Co. Ltd.<br /> No. 186, 1st Floor, 1st Cross<br /> Raghavendra Complex<br /> Hosur Main Road, Wilson Garden<br /> Bangalore 560 027 Opposite Parties<br /> <br /> ORDER<br /> By the Member Smt. D. Leelavathi<br /> <br /> This is a complaint filed by the complainant under section 12 of the Consumer Protection Act.<br /> The complainant is covered under Opposite parties Health shield Insurance Scheme policy bearing No. HC0000067000101 under gold plan to an extent of Rs.1,00,000/-. On the advice of doctors the complainant underwent an operation at Narayana Hrudalaya Hospital on 18/08/2003 and underwent a surgery since the complainant had Elective Coronary Artery Bye-pass Graft. At the time of discharge he was charged Rs. 1,40,000/- which the complainant has paid. The claim form was submitted along with all the documents to the opposite parties. The opposite parties disallowed the claim since the Angiogram report contained that the complainant was Hypertensive and Diabetic. The Complainant after 6 yrs issued a legal notice on 29/10/2009 for which the opposite parties have not replied. Hence the complainant has filed the present complaint claiming Rs. 1,25,000/- along with interest at 12% per annum from the date of his claim dated 25.09.2003.<br /> 2. Heard the complainant and notices were issued to the opposite parties. Opposite parties put in their appearance through their counsel and filed the version and affidavit enclosure also. In the version and evidence of opposite parties their main contention is that the complaint is not maintainable since it is barred by limitation. In the version the opposite parties have stated that after scrutinizing the complainant’s papers the panel of doctor observed that the complainant was admitted for unstable angina and underwent CABG for the same and he is a known case of hypertension and DM for last 10 and 2 yrs which can lead to CAD. Hence the claim was not admissible and in the exclusions Hypertension and Diabetes is considered as Pre-Existing and also the amount claimed by the complainant is the insured cannot claim anything more than what is covered by the insurance policy at the statutory limitation of the policy. Hence, there is no negligence or deficiency of service of opposite parties.<br /> 3. The points for consideration are:<br /> 1. Whether the complaint is maintainable?<br /> 2. Whether the complaint is barred by limitation?<br /> 4. The complainant has not filed any application for condonation of delay under section 24-A of the Consumer Protection Act, 1986. This complaint is filed after six years after repudiation of the claim. The claim was repudiated on 11.12.2003 and the complaint is filed on 12.03.2010. The claim is barred by the limitation since the limitation has expired on 11.12.2005 itself. The complainant has not produced any evidence to substantiate the grounds of delay. So delay cannot be condoned. Under Section 24 A – “limitation period - The District Forum and the State Commission or the National commission shall not admit a complaint unless it is filed within two years from the date on which the cause of action has arisen”.<br /> 5. In the citation given by the opposite parties the national commission has held in Sudma lal Madhwani Vs New India Assurance Co. Ltd., (II (2007) CPJ 144(NC)) that the limitation period starts from the date of repudiation of the claim. It is clearly established in the present complaint that the claim has been barred by the limitation since the limitation expired on 11.12.2005 itself. So the complaint is not maintainable under the Act. Hence, the complaint is Dismissed.<br /> ORDER<br /> 6. The complaint is dismissed. No order as to costs.<br /> 7. Send the copy of this Order to both the parties free of costs immediately. <br /> 8. Pronounced in the Open Forum on this 04TH DAY OF NOVEMBER 2010. <br /> Order accordingly,<br /> <br /> MEMBER<br /> We concur the above findings.<br /> <br /> MEMBER PRESIDENT<br />