In  the  Court  of  the

Consumer Disputes Redressal Forum, Unit -I, Kolkata,

8B, Nelie Sengupta Sarani, 4^th Floor, Kolkata-700087.

CDF/Unit-I/Case No.  479 / 2009.

1)                   Md. Abu Tarique,

            106/2, Karaya Road, 1^st Floor, Flat no.3,

            Post Office Circus Avenue, Kolkata-700017.                                            ---------- Complainant

---Versus---

1)                   Star Health and Allied Insurance Co. Ltd.,

            1, New Tank Street, Valluvarkottam, Chennai-600034.

            Zonal Office-71, Park Street, Kolkata.

            Branch Office-Howrah(191113), 53, Debson Road, Howrah-711101.          ---------- Opposite Party

Present :           Sri Sankar Nath Das, President.

                        Dr. Subir Kumar Chaudhuri, Member.

                        Smt. Sharmi Basu, Member

Order No.   21    Dated  21/05/2012.

The petition of complaint has been filed by the complainant Md. Abu Tarique against the o.ps. Star Health and Allied Insurance Co. Ltd. The case of the complainant in short is that complainant had ‘Star Senior Citizen’ Red Carpet Insurance policy issued by o.ps. being latest policy no.P/191113/01/2010/000037 and with  the previous policy no.P/190000/01/2009/000526 and complainant is not defaulter in the matter of making payment.

Further case of the complainants is that on 13.9.08 complainant had to be admitted to the Heart Hospital, chandralay, Kankarbag, Patna, Bihar having breathing problem, blood sugar, etc and was under consultation of Dr. A.K. Thakur and complainant was admitted with chest discomfort for 10 days and he made claim on 18.11.08 of Rs.16,529/-. O.ps. sent letter on 20.12.08 to complainant for submission of certain documents like discharge summary, hospital bills, etc. but o.p. did not ask for production of any document of previous history of disease as per his claim dt.18.11.08 and complainant made representation on 10.2.09 to this effect which was duly received by o.p. on 11.2.09 and on 11.2.09 o.p. sent a cheque of Rs.4901/- vide no.258873 drawn on HDFC Bank and further case of the complainant is that there arose subsequent cases of hospitalization of dialysis for which complainant had to be admitted to the hospital and submitted claim of Rs.1,17,536.35 and subsequently complainant on 24.6.09 received a letter from o.ps. wherefrom it reveals that his claim was not admissible under the policy as the type of disease was not disclosed earlier and o.ps. repudiated the claim of complainant of complainant vide letter dt.24.4.09 for ‘non-discloser of material facts’. Hence the case.

O.ps. had entered their appearance in this case by filing w/v and denied all the material allegations labeled against them. Ld. lawyer of o.ps. in the course of argument vehemently opposed the claim of complainant stating that the claim is not permissible under the policy since the material facts were not disclosed by complainant prior to policy and prayed for dismissal of the case.

Decision with reasons:

We have gone through the pleadings of the parties, evidence and documents in particular. It is an admitted fact that complainant had policy with o.ps. and o.ps. repudiated the claim of complainant for pre-existing disease. We are of the view that o.ps. ought to have examined by their panel doctors prior to issuance of insurance policy. It is a settle principle of law that the liability of the insurance company starts running with the payment of 1^st premium and insurance company cannot shirk off their responsibility simply on the plea of violation of insurance provision etc. We are of the view that the insurance company is duty bound to pay the claim of complainant when complainant is not a defaulter as we come to find from the materials on record and such non-payment of claim of complainant by o.p. amounts to gross deficiency on the part of o.ps. and we further hold that complainant is entitled to relief.

Hence, ordered,

That the petition of complaint is allowed on contest with cost against the o.ps. O.ps. are jointly and/or severally directed to pay Rs.75,000/- (Rupees seventy five thousand) only together with interest @ 9% p.a. from the date of claim till the date of realization and are further directed to pay compensation of Rs.15,000/- (Rupees fifteen thousand) only and litigation cost of Rs.5000/- (Rupees five thousand) only within 45 days from the date of communication of this order, i.d. an interest @ 9% p.a. shall accrue over the entire sum due to the credit of the complainant till full realization.

Supply certified copy of this order to the parties. 

        _____Sd-_______             _____Sd-_______              ______Sd-______

          MEMBER                         MEMBER                       PRESIDENT