Chandigarh

StateCommission

A/218/2019

Max Bupa Health Insurance Company Ltd. - Complainant(s)

Versus

Supriya - Opp.Party(s)

Gaurav Bhardwaj, Karandeep Singh Cheema & Chetan Gupta Adv.

01 Nov 2019

ORDER

        STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

U.T., CHANDIGARH

 

 

Appeal No.	:	218 of 2019
Date of Institution	:	25.09.2019
Date of Decision	:	01.11.2019

 

1. Max Bupa Health Insurance Co. Ltd., B-1/1-2, Mohan Cooperative Industrial Estate, Mathura Road, New Delhi – 110044.

 

2. Max Bupa Health Insurance Co. Ltd., SCO No.55-56-57, Sector 8-C, Madhya Marg, Chandigarh.

 

…….Appellants/Opposite Parties.

Versus

 

1. Supriya Arora daughter of Shri Manohar Lal Arora, resident of House No.65, Seori Bitna, Pinjore, Kalka, District Panchkula presently residing at 15 Valmiki Street, Flat No.B2 Ceebros Castel T Nagar, Chenna.
2. Manohar Lal Arora son of Sh. Pratap Chand Arora resident of House No.65, Seori Bitna, Pinjore, Kalka, District Panchkula.

 

...Respondents/Complainants.

 

Appeal under Section 15 of the Consumer Protection Act, 1986

 

BEFORE: JUSTICE RAJ SHEKHAR ATTRI, PRESIDENT.

                MRS. PADMA PANDEY, MEMBER.

                MR. RAJESH K. ARYA, MEMBER.

       

Argued by:

 

Sh. Gaurav Bhardwaj, Advocate for the appellants.

Ms. Supriya Arora, respondent No.1/complainant No.1 in person.

 

PER  RAJESH  K.  ARYA, MEMBER

                   In this appeal laying challenge to order dated 24.07.2019 passed by District Consumer Disputes Redressal Forum-II, U.T., Chandigarh (in short ‘the Forum’ only) in Consumer Complaint bearing No.688 of 2018, the opposite parties are seeking setting aside of the said order on the ground that the order passed is completely arbitrary based on conjectures and surmises, against the documents and pleadings on record.

2.             It may be stated here that the Forum, while directing the opposite parties to restore the policy, in question, also directed to reimburse the claim amounts alongwith interest @8% p.a. from the date of filing the complaint. Apart from above, it also awarded Rs.15,000/- as compensation for harassment & mental agony and Rs.7,000/- towards litigation expenses.

3.             It is also not out of place to mention here that the complainants had also filed appeal bearing No.226 of 2019 seeking enhancement of relief awarded by the Forum vide the order impugned. The said appeal was dismissed by this Commission vide order dated 11.10.2019 and while doing so, this Commission held in Paras 4 to 7 as under:-

“4.               It is not in dispute that the complainants took Family First Silver 5 Lacs + 15 Lacs Mediclaim Insurance policy in November 2016 wherein, it was clearly mentioned that complainant No.2 was suffering from Diabetes since 2012.  The said policy was got renewed by the complainants for further period from 8.11.2017 to 7.11.2018, during which period, admittedly, appellant No.2 took treatment twice i.e. from 1.4.2018 to 15.4.2018 and 18.4.2018 to 23.4.2018, at Fortis Hospital, Mohali.  However, the claims lodged by the complainants qua medical expenses incurred was rejected by the opposite parties.

5.                The Forum has given a categoric finding that the opposite parties have not only wrongly & illegally rejected both the claims of complainant No.2 but also illegally cancelled the policy, in question, thus, depriving them from the benefit of the said policy. The Forum has also rightly held that complainant No.1 applied for the renewal of the policy by submitting cheque amounting to Rs.41,000/- towards the premium but the same was declined by the respondents, which further amounted to deficiency in service on their part. Not only this, the Forum has also observed that Insurance Certificate (Annexure C-1) and proposal form make it clear that complainant No.2 clearly mentioned about his pre-existing diseases i.e. Diabetes Mellitus and Hypertension suffering since 2012 at the time of availing the policy. It also rightly held that no authentic document was placed on record by the opposite parties to establish that complainant No.2 was suffering from Hypertension and Diabetic Mellitus since 17 years and as such, there was no question of any concealment or misrepresentation on the part of the complainants and rejection of claim as well as cancellation of policy on that ground was highly objectionable and not justified.

6.                The Forum, while directing the opposite parties to restore the policy, in question, also directed to reimburse the claim amounts alongwith interest @8% p.a. from the date of filing the complaint. As per argument raised by the appellants/complainants, the rate of interest awarded by the Forum is on the lower side and it should have been awarded from the date, when cause of action arose in favour of the complainants. We reject this argument. In our opinion, 8% interest, in these days, cannot be said to be on the lower side. These days, the banks in saving bank accounts are giving interest ranging between 3.50% to 4% and on Fixed Deposit Receipts, a maximum of 6% to 6.50% depending upon the term and amount of such deposit. Immediately after repudiation, the complainants filed the complaint on 04.12.2018 and the Forum rightly awarded interest from the said date. Thus, in our considered opinion, interest @8% p.a. awarded by the Forum, which is more than the prevailing market rate of interest, on the claim amounts from the date of filing the complaint i.e. 04.12.2018 till date of realization, is just and adequate.

7.                The next argument raised qua lesser award of compensation for causing harassment & mental agony and litigation expenses by the Forum is also rejected being unsustainable in the eyes of law. In our considered opinion, taking into consideration the sufferance and harassment suffered by the complainants, they (complainants) have adequately and sufficiently been compensated by the Forum by way of interest awarded @8% p.a. besides award of Rs.15,000/- as compensation for harassment & mental agony and Rs.7,000/- towards litigation expenses.”

4.             On the basis of material and evidence available on record, once this Commission has upheld the impugned order passed by the Forum whereby it has held that no authentic document was placed on record by the opposite parties to establish that complainant No.2 was suffering from Hypertension and Diabetic Mellitus since 17 years and as such, there was no question of any concealment or misrepresentation on the part of the complainants and rejection of claim as well as cancellation of policy on that ground was highly objectionable and not justified.

5.             In view of above, the appellants/opposite parties are not entitled to any relief from this Commission, once each and every aspect of the case, on merits, has already been rightly dealt with by the Forum and upheld by this Commission. Accordingly, the appellants/complainants have failed to make out any case for setting aside the impugned order.

6.                    For the reasons recorded above, the appeal filed by the opposite parties is dismissed being devoid of merit with no order as to costs. The impugned order dated 24.07.2019 passed by District Forum-II, U.T., Chandigarh in Consumer Complaint bearing No.688 of 2018 is been upheld.

7.             Certified copies of this order, be sent to the parties, free of charge.

8.             The file be consigned to Record Room, after completion.

Pronounced.

01.11.2019.

[RAJ SHEKHAR ATTRI]

PRESIDENT

 

 

(PADMA PANDEY)

        MEMBER

 

 

(RAJESH  K. ARYA)

MEMBER

Ad