PRESENT

                   Complainant in person.  

                    Opponent Ex parte.                        

ORDER

(Per- Mr. S. D. MADAKE, Hon’ble President.)

1. The Complainant is working as insurance adviser. He has taken medi-claim insurance policy from opponent insurance company for him, his wife and three children wide policy no. P/171116/01/2014/015237. The name of the policy is FAMILY HEALTH OPTIMA NEW, which was valid for a period from 29/01/2014 to 28/01/2015.

2. The complainant stated that his daughter namely Khushi was hospitalize and amount of Rs,22,206/- was paid for the treatment.

3. The complainant stated that he submitted documents as per the direction of the insurance company as per letter dated 31/07/2014 sent by opponent.

4. It is submitted that Dr. Vivaswan Parekh (M.D.) stated that child was not required any hospital admission except in 2007 and 2014.

5. The complainant contended his daughter was not having seizure disorder for seven years. The opponent has rejected the claim. The opponent has not renewed the policy for his daughter Khushi though premium has been paid for more than four years.

6. The complainant prayed for payment of Rs.22,206/- with interest which are paid for treatment of Khushi with compensation for mental agony. He prayed that name of Khushi should be included in the policy.

7. As the opponent remained absent and failed to file written version, this forum passed Ex-parte order on 18/05/2016. We have perused the documents produced on record. The opponent failed to prove that complainant suppressed material facts about the illness of Khushi. The certificate issued by Dr. Vivaswan Parekh (M.D.) is not supported by an affidavit. The evidence of complainant has gone unchallenged.

8. The complainant has taken the policy and in the renewed policy the name of Khushi is deleted. As the complainant entered into valid agreement by taking the policy excluding his daughter Khushi is not entitled to pray for her inclusion in the said policy. We are of the view that complainant is entitled for an amount paid for treatment of Khushi supported by documents. The insurance company is liable to pay the same.

9. We proceed to pass the following order.     

ORDER

1.       The complaint No. 114/2015 is partly allowed.

2.        The Star Health and Insurance Company ltd is directed to pay the amount

           of Rs.22,206/- to complainant with interest @ 9% p.a. from the date of

          admitting this complaint.

3.        No order as to cost.

4.       Copy of this order be sent to both parties.