DISTRICT CONSUMER DISPUTES REDRESSSAL FORUM

WEST TRIPURA : AGARTALA

 

CASE NO:  CC – 01  of   2018

 

Sri Satya Ranjan Pal,

S/O- Late Mahendra Ch. Pal,

Kunjaban Colony,

P.O. Abhoynagar, Agartala,

West Tripura. …........…...Complainant.

 

           -VERSUS-

 

1. The ICICI Lombard General Insurance Company Ltd.,

Represented by its General Manager,

Registered office at ICICI Lombard House, 

414, Veer Savarkar Marg, Near Siddhi Vinayak Temple,

Prabhadevi, Mumbai- 400 025.

 

2. Falck Global Assistance, Claims Department,

C/O- Falck India Pvt. Ltd., Upper Floor, the Peach Tree,

Block -C, Sushant Lok- I, Sector 43,

Gurgaon, Haryana- 122 015.

 

3. The ICICI Lombard General Insurance Company Ltd.,

Represented by the Branch Manager, 

Having its Branch office at GRS Tower, 

2nd Floor, RMS Chowmuhani, Agartala- 799001. ........... Opposite Parties.

 

__________PRESENT__________

 

 SRI A. PAL,

PRESIDENT,

  DISTRICT CONSUMER 

 DISPUTES REDRESSAL FORUM,

      WEST TRIPURA, AGARTALA. 

 

SMT. DR. G. DEBNATH

MEMBER,

  DISTRICT CONSUMER 

DISPUTES REDRESSAL FORUM, 

  WEST TRIPURA,  AGARTALA.

 

SRI U. DAS

MEMBER,

  DISTRICT CONSUMER 

DISPUTES REDRESSAL FORUM, 

  WEST TRIPURA,  AGARTALA.

 

C o u n s e l

For the Complainant : Sri Nirmal Ch. Paul,

  Sri Ratnadeep Paul,

  Advocates.

 

For the O.P. No.1 : Sari Tanmay Chaudhury,

  Advocate.

 

For the O.P. No.2 & 3 :  None appeared.   

 

 

JUDGMENT   DELIVERED   ON:  14.06.2018.

 

J U D G M E N T

This case arises on the petition filed by Satya Ranjan Pal U/S 12 of the Consumer Protection Act. Petitioner's case in short is that he purchased one health Insurance Policy from ICICI Lombard General Insurance Company Ltd., Opposite party. Date of issue of the policy was 28 the April 2017. Insurance was valid for a period of from 12th May 2017 to 25th September 2017. Complainant went to Chicago, America on 12th May, 2017. During his stay at America, Chicago complainant suffered illness. He had to take treatment for Bronchitis with Bronchopasm, asthma and paid  $3,763/- as treatment cost. On return to India he claimed the amount from the Insurance company. But his claim was repudiated by the company on the ground that he had suppressed the past medical history of Cardiac ailment. Being aggrieved and dissatisfied by such decision petitioner filed this prayer for  direction the receive the treatment cost Rs. 2,42,667/- and also Rs.80,000/- for harassment and litigation cost. 

2. After filing of the case notice was sent to the O.P., ICICI Lombard General Insurance Company. Agartala Branch received the notice on 24th January 2018. Notice to other O.Ps also sent by speed post. O.P. No.1, ICICI Lombard General Insurance company appeared, filed written statement denying the claim. Thereafter did not appear to support the written statement or give any evidence. So, evidence of complainant side was recorded.

3. Complainant side produced the original policy, documents related to treatment papers at America, bills, cash memos, letters, discharge summary. Also produced the statement on affidavit of one witness, Satya Ranjan Pal. Delivery report of the consignment was also produced.

4. On the basis of all evidences given by the petitioner we will decide the case. 

Findings and decision:

5. O.P. No.1 in the written statement alleged that the petitioner suppressed the past illness. In the policy itself it is written that any claim arises on any preexisting disease whether declared or  undeclared is not covered by the policy.

6. In this case only contention is that petitioner suppressed his past illness. Petitioner Satya Ranjan Pal in his statement on affidavit stated that he informed his past medical history record, his bypass surgery. When he went to Chicago, America he did not suffer from heart ailment but from acute Bronchitis with bronchopasm.

7. We have gone through the policy certificate and found that basic premium Rs.35,944/- was paid. The period of the policy is from 12th May, 2017 to 25th September, 2017. It is established fact that within the policy period petitioner suffered the disease. In the exclusion cause of the policy it is written that any claim due to or arising out of preexisting medical condition is not covered under the policy. Petitioner had the heart ailment but have no history of Bronchopasm or bronchitis. The documents required as per policy was submitted. But the claim was repudiated on the ground of preexisting disease. O.P. failed to produce any single evidence to support that petitioner suffered bronchitis due to his preexisting heart ailment. So, such plea taken by the O.P. Insurance company is baseless and is not supported by any evidence.

8. We have gone through the prescription and the cash memo along with medical report and examination report. It is written that petitioner suffered from Acute bronchitis with bronchopasm on 14.07.17. From the cash memo it is found that he spent total $3,763 equal to Indian currency Rs.2,42,667/- for treatment purpose. Petitioner was entitled to get it as per the terms of the Insurance policy. But O.P. denied the claim and harassed the petitioner. Therefore, petitioner is entitled to get the amount along with compensation for harassment and also cost of litigation.

9. We therefore, direct the O.P. Lombard General Insurance company to pay treatment cost Rs.2,42,667/- and also compensation Rs.20,000/-(Rupees Twenty Thousand) for harassment and Rs.10,000/-(Rupees Ten thousand) for litigation cost. In total O.P. will have to pay Rs.2,72,667/-(Rupees Two lac Seventy Two Thousand Six Hundred Sixty Seven) Indian currency to the petitioner. Payment is to be made within 2(two) months if not paid it will carry interest @ 9% P.A. 

 

    Announced.

 

 

 

SRI A. PAL

PRESIDENT,

DISTRICT CONSUMER  DISPUTES 

REDRESSAL FORUM,

WEST TRIPURA,  AGARTALA.

 

 

 

SMT. DR. G. DEBNATH,

MEMBER,

 DISTRICT CONSUMER DISPUTES 

REDRESSAL FORUM, 

WEST TRIPURA, AGARTALA SRI  U. DAS

MEMBER,

 DISTRICT CONSUMER DISPUTES 

REDRESSAL FORUM, 

WEST TRIPURA, AGARTALA