- Bimal Kanti Basu,
209, Jodhpur Park,
Kolkata-68, P.S. Lake. _________ Complainant
____Versus____
- Tata AIG General Insurance Co. Ltd.
Constantia Complex, 2nd Floor,
11, U.N. Brahmachari Street,
Kolkata-17, P.S. Shakespeare Sarani.
- Mr. Ardhendu Saha,
19/2, Ram Mohan Roy Road,
Agent / Representative,
Tata AIG General Insruance Co. Ltd.
Kolkata-8, P.S. Behala. ________ Opposite Parties
Present : Sri Sankar Nath Das, Hon’ble President
Dr. Subir Kumar Chaudhuri, Member.
Order No. 22 Dated 21-04-2015.
The case of the complainant in short is that complainant obtained a Travel Guard Travel Insurance from o.p. upon deposition of requisite premium for the purpose. The said insurance being no.GC298724 was valid for 5 years i.e. from 17.5.05 to 17.5.10. Complainant went to USA sometimes in June 2010 and returned in July 2010. Pacemaker had been installed to the complainant on 18.6.04. During his stay at USA the battery of the pacemaker was found depilated and as a result of which complainant had to reimplant pacemaker on 27.5.10. After returning at Kolkata complainant submitted the claim form to o.p. for reimbursement of the amount incurred by him towards reimplanted of the pacemaker during his stay at USA by virtue of holding the Travel Guard Travel Insurance with o.p. company.
Upon receiving the claim form, complainant stated that o.p. company had repudiated the claim on the ground that “The policy does not provide any benefit for any expenses incurred directly or indirectly in respect of any pre-existing condition or any complication arises from it”. The repudiation had been communicated by o.p. to the complainant on 7.9.10.
Upon aggrieved complainant filed the instant case before this Forum with the prayers contained in the prayer portion of the petition of complaint.
O.p. had appeared before this Forum and contested the case by filing w/v. O.p. during the submission stated that they have not made any deficiency of service towards the complainant since the repudiation as stated above which has been communicated to the complainant is very much in the terms and conditions of the relevant policy and o.p. has annexed the terms and conditions in this regard with the w/v. O.p. further stated that they have prepared the terms and conditions as per the guidelines of IRDA. So, they have nothing to do if such exclusion clause is there in the terms and conditions and they must abide the said guidelines of the relevant insurance policy.
Decision with reasons:
Upon considering the submissions of both the parties and on careful scrutiny of the entire materials on record, this Forum hold that o.p. had not made any deficiency to the complainant since in the terms and conditions of the relevant policy, it is clearly stated that they would not provide any benefit for any expenses incurred directly or indirectly in respect of any pre-existing disease or any complications arising out of it. Since it is evident from the record that pacemaker had been implanted to the complainant in June 2004 i.e. very much pre-existing prior to commencing of the instant policy since the instant policy was for 5 years i.e. from 17.5.05 to 17.5.10.
In view of the above, this Forum hold that o.p. had not made any deficiency as service provider to the consumer / complainant and complainant is not entitled to relief.
Hence, ordered,
That the case is dismissed on contest without cost against the o.p.
Supply certified copy of this order to the parties free of cost.
