NEW INDIA ASSURANCE COMPANY LIMITED Vs. SHASHI RANI W/O LATE SH VINOD KUMAR SINGHAL
LAWS(UTNCDRC)-2013-10-2
UTTARAKHAND STATE CONSUMER DISPUTES REDRESSAL COMMISSION
Decided on October 03,2013

NEW INDIA ASSURANCE COMPANY LIMITED Appellant
VERSUS
Shashi Rani W/O Late Sh Vinod Kumar Singhal Respondents

JUDGEMENT

- (1.) THIS is insurer's appeal under Section 15 of the Consumer Protection Act, 1986 against the order dated 19.03.2010 passed by the District Forum, Dehradun in consumer complaint No. 26 of 2006. By the order impugned, the District Forum has allowed the consumer complaint and directed the appellant opposite party to pay sum of Rs. 2,00,000/ - to the respondents complainants together with interest @7% p.a. from the date of filing of the consumer complaint till payment.
(2.) BRIEFLY stated, the facts of the case as mentioned in the consumer complaint, are that late Sh. Vinod Kumar Singhal, the deceased husband of respondent No. 1 and father of respondent Nos. 2 to 4, had during his lifetime, purchased a Hospitalisation and Domiciliary Hospitalisation Benefit Policy from the appellant The New India Assurance Company Limited for himself as well as his wife for insured sum of Rs. 2,00,000/ - each. The said policy was valid for the period from 08.09.2004 to 07.09.2005. It is alleged that after taking the said policy, the insured late Sh. Vinod Kumar Singhal suffered heart attack and was admitted in Indraprastha Apollo Hospital, New Delhi, where he had to undergo surgery for Double Valve Replacement and CABG grafts. The claim for reimbursement of the medical expenses was lodged with the insurance company and the required documents were also submitted with the insurance company. However, the claim lodged was repudiated on the ground that the claim falls under exclusion clause No. 4.2 of the policy and that the discharge summary states that he was suffering from hypertension since 15 years, which falls under exclusion clause No. 4.1 of the policy. Thus, alleging deficiency in service on the part of the insurance company, a consumer complaint was filed before the District Forum, Dehradun by late Sh. Vinod Kumar Singhal, who unfortunately died during the pendency of the consumer complaint and, as such, his legal heirs were substituted in his place.
(3.) THE insurance company filed written statement before the District Forum and pleaded that the policy was taken on 08.09.2004 and late Sh. Vinod Kumar Singhal was admitted in Indraprastha Apollo Hospital, New Delhi on 04.10.2004, within 26 days of taking the policy and hence the claim was not payable; that in the discharge summary of late Sh. Vinod Kumar Singhal issued by Indraprastha 2Apollo Hospital, New Delhi, it was clearly written that he was suffering from hypertension since last 15 years, which fact was not disclosed by him in the proposal form at the time of taking the policy and that the claim lodged was rightly repudiated and no deficiency in service was made by the insurance company. The District Forum, on an appreciation of the material on record, allowed the consumer complaint vide impugned order dated 19.03.2010 in the above terms. Aggrieved by the said order, the insurance company has filed this appeal.;


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