Haryana

StateCommission

A/203/2016

BIRLA SUN LIFE INSURANCE CO. LTD. - Complainant(s)

Versus

VINOD KUMAR - Opp.Party(s)

NITIN THATAI

16 Jan 2017

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

HARYANA PANCHKULA

 

 

First Appeal No.203  of 2016

Date of the Institution:09.03.2016

Date of Decision:16.01.2017

 

1.      Birla Sun Life Insurance Company, one Indiabulls Centre, Tower 1, 15^th and 16^th Floor, Jupiter Mill Compound, 841, Senapati Bapat Marg, Elphinstone Road, Mumbai, through M.S. Aakriti Manocha, Assistant Manager-Legal.

2.      Birla Sun Life Insurance Company Main Market, 1^st Floor of HDFC Bank, Sector 14, Sonepat through its Branch Manager.

                                                                             .….Appellant

Versus

Vinod Kumar son of Roop Ram R/o Village Kharkhoda, Tehsil Khardkhoda, District Sonepat.

                                                                                                .….Respondent

CORAM:    Mr.R.K.Bishnoi, Judicial Member

                    Mrs. Urvashi Agnihotri, Member

 

Present:-    Mr.S.C. Thathai, Advocate counsel for the appellant.

                    Mr.Uday Chauhan, Advocate counsel for respondent.

 

O R D E R

URVASHI AGNIHOTRI, MEMBER:

1. Birla Sun Life Insurance Company and Anr. -OPs are in appeal against the Order dated 17.11.2015 passed by the learned District Consumer Disputes Redressal Forum, Sonepat (for short ‘District Forum’), whereby the complaint of Vinod Kumar- complainant has been allowed by directing the OPs as under:-

“Accordingly, we hereby direct the respondent to make the payment of Rs.1,50,000/- or Rs.1,48,800/-(if cheque of Rs.1200/- got encashed by the complainant) to the complainant within a period of 45 days from the date of passing of this order, failing which, the above said amount shall fetch interest at the rate of 09% per annum from the date of passing of this order till its realization”.

2. Briefly stated, according to the complainant, he got himself insured under mediclaim cashless policy vide policy No.04434346, dated 30.09.2010, which was to mature on 30.09.2040 from the Respondents. During this period, the complainant fell ill and got treatment from Shri Balaji Action Medical Instt. New Delhi and spent Rs.1,79,840/- on his treatment.  But the respondents instead of making the said payment, sent a cheque of Rs.1200/- only to the complainant, which was grave deficiency in service on their part. Aggrieved against this, the complainant approached the District Forum for the redressal of his grievance.
3. Pursuant to notice, the opposite party appeared and filed the written reply agitating that the Complainant had submitted an application for insurance on his own name for BSLI Dream Endowment plan for sum assured of Rs.4,03,680/- with hospital care rider for sum assured of Rs.1,50,000/-. The Policy was admittedly handed over to the complainant on 28.10.2010 and at the time of filling the above said proposal form, the complainant opted to pay the premium for first year.  Therefore, the respondents have not committed any unfair trade practice as the complainant himself violated the terms and conditions of the policy.  However, the learned District Forum rejected the pleas raised by the OP and accepted the complaint vide order dated 17.11.2015 by granting the aforesaid relief. 
4. Against the impugned order, the OP/appellant has filed appeal before us reiterating their pleas as raised before the District Forum. We have heard the learned counsel for the parties and have gone through the record. From the perusal of the record its stands established that the complainant Vinod Kumar had only submitted the requisite application form for getting himself insured and all other formalities were completed by the officials of the insurance company. No term and condition of the policy was either brought to the notice of the complainant or was incorporated in the Policy under which the complainant had consented to accept the clause regarding the payment of Rs.1200/-. The appellant have failed to produce any documentary evidence or any other material on record showing their criteria justifying their action of paying Rs.1200/- only to the complainant against the insured  amount of  Rs.1,50,000/-. The complainant had actually taken the treatment from the hospital mentioned above during the validity of the insurance policy within the rider sum of Rs.1,50,000/-. Therefore, there was no reason that complainant was not entitled for a sum of Rs.1,50,000/-, which entitlement was not even denied by the OPs in their reply. Therefore, the pleas raised by the insurance company are wholly without any basis and just an excuse to repudiate the genuine claim of the complainant.
5. Consequently, we fully endorse the conclusion arrived at by the learned District Forum and uphold their Order. The appeal filed by the OPs is dismissed with no order as to costs.
6. The statutory amount of Rs.25,000/- deposited at the time of filing the appeal be refunded to the appellant against proper receipt and identification in accordance with rules.

 

January 16th, 2017

Mrs.Urvashi Agnihotri, Member, Addl.Bench

R.K.Bishnoi, Judicial Member Addl.Bench

 

R.K.