Per Mr. S.R. Khanzode, Hon’ble Judicial Member :
This appeal takes an exception to an order dated 24.1.2011 passed in consumer complaint No. 226/2010, Shri Sunil C. Hendre V/s Sr. Divisional Manager, LIC of India and Ors., passed by the Consumer Disputes Redressal Forum, Satara. Undisputed facts are that the respondent No. 1 Sunil (hereinafter referred to as a complainant) had taken LIC Health Plus Unit Linked Health Insurance Plan (T.No.901), hereinafter referred to as the Policy, for the period 14.6.2008 to 14.6.2023. The complainant was subject to hospitalization since he suffered from Single Vessel Disease with Significant Right Renal Artery Stenosis. A stent to right renal artery was implanted. Hence he made mediclaim. It was partly allowed i.e. for his hospitalization amount of `12,600/-was paid. However, expenses of `79,200/- towards artery stenosis rejected since it fall beyond the cover offered under the policy. Feeling aggrieved by this, consumer complaint was filed. The Forum while awarding the claim of the complainant, found that the terms of the policy on which appellant is relying were not supplied to the complainant. Feeling aggrieved thereby, original opponent Nos. 1 & 3 (i.e. LIC of India and its Sr. Divisional Manager at Satara) preferred this appeal.
Admit only against respondent No.1. With the consent of both the parties, heard forthwith.
The point as to whether the terms of the policy which used for repudiating the claim, were supplied to the complainant is only raised. Admittedly, as submitted by the respondent No.1, there is no affidavit filed on his behalf under section 13(4) of the Consumer Protection Act, 1986. In evidence, appellant LIC of India has filed affidavit of his official Mr. Prabhakar Tukaram which is dated 2.11.2010. He has submitted that the documents including the details of benefits under the policy were supplied to the complainant. The policy document of LIC of India which describes the benefits of the policy are also produced on record. The first covering page also refers to the documents attached with it. Admittedly, the first covering page is received by the complainant and it is revealed that the complainant has never complained about non-receipt of the attached documents as mentioned therein. From the material placed on record and the facts established, it cannot be said that the relevant documents shows which kind of surgery was covered. Therefore, it cannot be said that repudiation of claim by the LIC of India was improper. Therefore, no deficiency in service on the part of the LIC of India can be held as established. Under the circumstances, we hold accordingly and pass the following order :
O R D E R
The appeal is allowed and impugned order dated 24.01.2010 stands set aside. In the result, the consumer complaint stands dismissed.
In the given circumstances, the parties to bear their own costs.
Pronounced dated 28th July 2011.
