Col. T.S. Bakshi, Retd., R/o H.No. 12, Sector 8/A, Chandigarh – 160009, Attorney of Jaspreet Singh Bakshi, S/o Col. (Retd.) T.S. Bakshi.

                                                                             .…Appellant

                                      Vs.

Star Health & Allied Insurance Co. Ltd., through the Branch Manager, Star Health and Allied Insurance Co. Ltd., SCO No. 257, 2^nd Floor, Sector 44-C, Chandigarh.

                                                                             …. Respondent

BEFORE:   JUSTICE SHAM SUNDER (RETD.), PRESIDENT

                MRS. NEENA SANDHU, MEMBER

Argued by: Col. T.S. Bakshi, appellant in person.

                   Sh. Rohit Rana, Adv. proxy for Sh. Kunal Dawar, Adv. for the respondent. 

MRS. NEENA SANDHU, MEMBER

                    This appeal is directed against the majority order dated 16.4.2012 (however, inadvertently the appellant/complainant mentioned the date 28.3.2012 i.e of minority order passed by single member), rendered by the District Consumer Disputes Redressal Forum-I, UT, Chandigarh (hereinafter to be called as the District Forum only) vide which, it dismissed the complaint, filed by the complainant.

2                   Briefly stated, the facts of the case, are that the complaint was filed by Col. T.S. Bakshi, Retd., who was the duly appointed attorney of the holders of the medical insurance policies namely Jaspreet Singh Bakshi, his wife Sangeeta Bakshi and son Sahej Bakshi, issued by the Opposite Party. It was stated that the policy document was issued for the period from 21.07.2010 to 20.07.2011, after receipt of premium vide Cheque dated 21.07.2010.  It was further stated that Sahej Bakshi one of the above said medical insurance policy holders, developed high temperature, with signs of dengue fever on 14.08.2010, while at Delhi. It was further stated that he was immediately rushed to Ashlok Hospital, Safdarjang Enclave, New Delhi, and on confirmation of dengue fever he was rushed to Chandigarh and got admitted in Fortis Hospital, Mohali on 15.08.2010. It was further stated that intimation, in this regard, was conveyed to the Opposite Party and it vide letter dated 31.08.2010 asked the Complainant to submit the required documents. The relevant documents were submitted by the Complainant to the Opposite Party vide letter dated 6.10.2010 but it arbitrarily vide letter dated 24.11.2010 repudiated the claim. It was further stated that the aforesaid act of the Opposite Party amounted to deficiency in service. Hence the complaint was filed.

3                   Reply was filed by the Opposite Party, wherein it was admitted that medical insurance policy to Sh. Jaspreet Singh Bakshi, Sangeeta Bakshi and Sahej Bakshi was issued for the period from 21.7.2010 to 20.7.2011.  It was stated that only after following due procedure and verifying each and every detail, the claim of the Complainant was rightly repudiated, in accordance with the terms and conditions of the policy because as  per exclusion clause no. 2 of the policy, “any disease contracted by the insured person during the first 30 days from the commencement date of the policy, the Company was not liable for any payment under the policy in question.”  whereas Sahaj Bakshi was admitted in the hospital on 15.8.2010 before the  aforesaid period of 30 days had expired. Hence the claim was not considered and, accordingly, the same was rightly repudiated. It was further stated that the insured was well aware of the terms and conditions of the policy and hence there was no deficiency on the part of the Opposite Party. The remaining allegations made, in the complaint, were denied.

4                   The parties led evidence, in support of their case.

5                   After hearing the Attorney of the complainant,  Counsel for the Opposite Party, and, on going through the evidence and record, the District Forum vide its majority order dismissed the complaint, as stated, in the opening para of this order

6                   Aggrieved by the order, passed by the learned District Forum, the appellant/complainant has filed the instant appeal. 

7                   We have heard the Counsel for the appellant in person, counsel for the respondent and, have perused the record, carefully.

8                   The appellant submitted that Jaspreet Singh Bakshi, his wife Sangeeta Bakshi and son Sahej Bakshi obtained medical insurance policy for the period from 21.7.2010 to 20.7.2011. It was further submitted that Sahej Bakshi one of the holders of Insurance Policy developed sign of dengue fever on 14.8.2012 and  was got admitted in Fortis Hospital Mohali on 15.8.2010. Intimation to the Opposite Party was given and as per their advice all the relevant documents were submitted to them. But the Opposite Party arbitrarily vide its letter dated 24.11.2010 repudiated the claim, on the ground, that as per the exclusion clause 2 of the Policy the claim within 30 days of the commencement of the policy was not to be entertained. It was further submitted that aggrieved by this act of the Opposite Party the complainant filed complaint before the District Forum and the same was rightly allowed by the Single Member, vide order dated 28.3.2012 but the District Forum vide majority order dated 16.4.2012, wrongly dismissed the complaint.  

9                   On the contrary, the Counsel for the Opposite Party, submitted that since the claim of Sahej Bakshi was made within 30 days of the commencement of Policy, therefore, as per exclusion clause 2 of the terms and conditions of the policy, he was not entitled to the same. He further submitted that hence the Majority order, passed by the District Forum does not suffer from any perversity and the same does not warrant any interference.

10                        The question, for determination, before us, is whether dengue is a disease or not?  In our view dengue is a disease spread by mosquitoes bite, transmitting the virus to human body, which causes infection, owing to which the person suffers from high fever and gets ill/sick which in some cases may cause death. The dictionary meaning of the disease is an unhealthy condition of the body (or part of it) or the mind; illness, sickness. It cannot be ruled out that a person suffering from dengue becomes unhealthy/sick and may even die. Therefore, we do not hesitate in holding that dengue is a disease. Since, in the present case, the insured namely Sahej Bakshi suffered from dengue, within 20 days of the commencement of policy, his claim was not covered under the medical Insurance Policy, as per exclusion clause 2, thereof. Exclusion Clause 2 clearly provides that the insured shall not be entitled to any amount spent by him for the treatment of disease contracted by him, during the first 30 days from the date of commencement of Policy. The appellant, who himself placed on record, the terms and conditions of the Policy could not say that he was not aware of the exclusion clause. Therefore, the claim of the insured was rightly denied by the Opposite Party. 

11                       If we see the case from another angle that dengue is not a disease as held by Lady Member of the District Forum, then, the insured-Sahej Bakshi could not claim any amount under the Medical Insurance Policy because under the said Policy he could only claim the expenses, incurred by him, on his medical
treatment for the disease, suffered by him.  Therefore, the appeal is liable to be dismissed, as, the majority order passed by the District Forum, is perfectly legal, and valid, and the same does not suffer from any perversity.  

12             In view of the above discussion, we are of the view that this appeal has no merit and the same is accordingly dismissed with no order as to costs. The majority order of the District Forum is upheld.

13             Copies of this order be sent to the parties, free of charge.