State Consumer Disputes Redressal Commission
Arvind vs Religare Health Insu.Co.Ltd. on 27 July, 2023
1 izdj.k Øekad lh-lh- % 53@2018 e/;izns'k jkT; miHkksDrk fookn izfrrks"k.k vk;ksx] 76] vjsjk fgYl] Hkksiky-
izdj.k Øekad lh-lh- % 53@2018 lafLFkr fnuakd 20-07-2018 vjfoan iq= Lo- Jh gtkjhyky] vk;q&24 o"kZ] fuoklh& xzke >kM+yk] ftyk 'kqtkyiqj ¼e-iz-½ &&&&&& ifjoknh fo:) 1- jsyhxs;j gsYFk ba';ksjsal dEiuh] }kjk eq[; izca/kd] jft-irk&iape ry] 19] pkoyk gkml] usg: iSysl] U;w fnYyh&110019 2- jsyhxs;j gsYFk ba';ksjsal dEiuh] }kjk izca/kd] irk& th-okbZ-,l-] Xykscy] IykWV ua- ,&3],&4] ,&5] lsDVj 125] uks,Mk] ;w-ih-&201301 3- jsyhxs;j gsYFk ba';ksjsal dEiuh] }kjk LFkkuh; 'kk[kk izca/kd] 'kk[kk ,e-ih-uxj] Hkksiky ¼e-iz-½1462023 &&&&& vukosndx.k %% le{k %% ekuuh; Jh ,l-,l- caly % ihBklhu lnL;
ekuuh; Jh Mh-ds- JhokLro % lnL;
%% i{kdkjx.k }kjk %%
ifjoknh dh vksj ls Jh Vh-vkj- lSuh] vf/koDRkk mifLFkrA vukosnd dh vksj ls Jh vkuan lkguh] vf/koDrk mifLFkrA 2 izdj.k Øekad lh-lh- % 53@2018 vkns'k ¼fnuakd 27@07@2023 dks ikfjr½ ekuuh; lnL; Jh ,l-,l- caly vuqlkj %& 1- ;g ifjokn miHkksDRkk lja{k.k vf/kfu;e 1986 dh /kkjk&17 ds vUrxZr izLrqr fd;k x;k gSA 2- izdj.k dk laf{kIr fooj.k ;g gS fd] ifjoknh vjfoan ds firk us fnuakd 01 flrEcj&2016 ls fnuakd 31 vxLr&2017 dh vof/k ds fy;s chek ikWfylh gsrq izhfe;e :i;s 9]935@& tek fd;k FkkA O;fDrxr nq?kZVuk ds fy;s vfrfjDr izhfe;e :i;s 1]750@& tek fd;s FksA chek dEiuh }kjk ifjoknh ds firk LoxhZ; Jh gtkjhyky dk LokLF; lEcU/kh chek :i;s 5]00]000@& rFkk O;fDrxr nq?kZVuk chek :i;s 25]00]000@& dk dOgj gksuk crk;kA chfer dh e`R;q fnuakd 06-09-2016 dks eksVjlk;dy nq?kZVuk esa gksuk crkdj] ifjoknh us chek dEiuh dks Dyse izLrqr fd;kA chek dEiuh }kjk Dyse bl vk/kkj ij fujLr fd;k fd] chfer O;fDr }kjk ikWfylh ysus ds le; tks izLrko QkeZ Hkjk Fkk] mlesa iwoZ chekjh ds rF; dks fNik;k x;kA chek dEiuh }kjk ifjokn fujLr djus ij] ifjoknh }kjk ;g ifjokn izLrqr fd;kA 3- vukosnd chek dEiuh us mRrj izLrqr dj crk;k fd] ifjoknh ds firk }kjk chek ikWfylh ysrs le; tks izLrko QkeZ Hkjk Fkk] ml izLrko QkeZ esa chekjh ds rF;ksa dks fNik;k] tks fd chek ikWfylh dh 'krZ dk mYya?ku gSA 4- rdksZa dk euu fd;kA vfHkys[k dk voyksdu fd;kA 3 izdj.k Øekad lh-lh- % 53@2018 5- vfHkys[k vuqlkj] ifjoknh ds firk ds }kjk chek ikWfylh ds fy;s fnuakd 31-08-2016 dks tks izLrko QkeZ izLrqr fd;k Fkk] ml izLrko QkeZ esa ifjoknh ds firk us bu lc iz'uksa dk mRrj udkjkRed fn;k gS] tks fuEukuqlkj gSa %& Question Does Any insured has PED ?* Cancer* Any cardiovascular/Heart Disease (including but not) limited to Coronary artery disease/ Rheumatic heart disease/ Heart Attack or Myocardial infarction / Heart failure/ Bypass Grafting or CABG /Angioplasty or PTCA/ Heart valve diseases/ Pacemaker implanation)* Hypertension/ High blood pressure ?* Any Respiratory disease/ Disease of Lungs, Pleura and airway (including but not limited to Asthma/Tuberculosis/Pleural effusion/ Bronchitis/ Emphysema)* Any disorders of the endocrine system (including but not limited to Pituitary/ Parathyroid/ adrenal gland disorders)* Diabetes Millitus type 1 or Diabetes on insulin or Diabetes associated with blindness or chronic foot ulcer* Any Neuromuscular (muscles or nervous system) disorder or Psychiatric disorders (including but not fimited to Motor Neuron Disease, Muscular dystrophies, Epilepsy. Paralysis, Parkinsonism multiple sclerosis, stroke, mental illness)* Liver Disease ?* Any disorders of Blood and/ or Immunity (including but not limited to bleeding or clotting disorders, Systemic Lupus Erythematosus, Rheumatoid Arthritis, Crohn's disease, Ulcerative Colitis)* 6- vfHkys[k esa i`"B&67] izn'kZ vkj&3] chek dEiuh us izLrqr dj] bl vuqlkj ifjoknh ds firk gtkjhyky Vh-ch- dk iS'ksVa gksdj] Vh-ch- dk jftLVªs'ku djk;k gqvk dkMZ 4 izdj.k Øekad lh-lh- % 53@2018 izLrqr gqvkA bl dkMZ vuqlkj] ifjoknh ds firk gtkjhyky Vh-ch- dh chekjh ls o"kZ 2015 dks ihfM+r Fks] chekj gh ekuk tk;sxkA 7- chek dEiuh us izn'kZ vkj&4] i`"B&71] ftlesa vjfoUn Lo;a ifjoknh ds dFku chek dEiuh us fy;s] mlesa ifjoknh us gh ;g dFku fd;k fd] nq?kZVuk ds igys ifjoknh ds firk dk LokLF; dk flfoy vLirky] 'kqtkyiqj esa 10 fnu ls bZykt py jgk FkkA 8- vfHkys[k vuqlkj] chfer dh e`R;q fnuakd 06-09-2016 dks gqbZ] ifjoknh us chek QkeZ fnuakd 31-08-2016 dks HkjkA chek ikWfylh fnuakd 01-09-2016 dks tkjh gqbZA nq?kZVuk fnuakd 06-09-2016 ls 10 fnu iwoZ ls gh ifjoknh ds firk dk bZykt ifjoknh us pyuk crk;k vFkkZr chek ikWfylh ds fy;s tks izLrko QkeZ Hkjk mlds iwoZ gh ifjoknh ds firk dk bZykt vLirky ea pyuk gksuk fl) gSA blls Li"V gS fd] ifjoknh ds firk us tks izLrko QkeZ Hkjk] mlds iwoZ ls ifjoknh ds firk chekj Fks] mudk bZykt py jgk FkkA bu rF;ksa dks ifjoknh ds firk us izLrko QkeZ esa ugha crk;kA 9- ifjoknh ds fo}ku vf/koDRkk dk rdZ gS fd] ifjoknh ds firk dh nq?kZVuk ls e`R;q gqbZ gSA nq?kZVuk dk chekjh ls dksbZ lEcU/k ugha gSA vr% chekjh ds rF; fNikus ds vk/kkj ij ifjokn fujLr ugha fd;k tk ldrkA chek dEiuh Dyse fujLr ugha dj ldrhA chek dEiuh us tks Dyse fujLr fd;k gS] og lgh ugha gSA 10- ifjoknh ds fo}ku vf/koDRkk dk ;g rdZ Lohdkj ;ksX; ugha gSA tc chek ikWfylh izkIr dh tkrh gS] chek ikWfylh gsrq izLrko QkeZ esa tks tkudkjh chek dEiuh }kjk pkgh tkrh gS] og egRoiw.kZ gksrh gSA ;fn og tkudkjh fNikbZ tkrh gS] xyr tkudkjh nh tkrh gS rks og vuqc/a k izHkko'khy ugha ekuk tk ldrkA 5 izdj.k Øekad lh-lh- % 53@2018 11- iz'uk/khu izdj.k esa ifjoknh ds firk }kjk fnuakd 31-08-2016 dks izLrko QkeZ Hkjk FkkA mijksDr foospuk vuqlkj iwoZ ls vFkkZr fnuakd 31-08-2016 ds iwoZ ifjoknh ds firk chekj Fks] mudk bZykt py jgk FkkA vr% bl rF; dh tkudkjh ugha fn;s tkus ls LokLF; dh tkudkjh ugha fn;s tkus ls] chek ikWfylh dh 'krZ dk mYya?ku gksus ls Dyse dh ik=rk ugha vkrh gSA 12- vukosnd ds fo}ku vf/koDRkk us rdZ ds nkSjku LIFE INSURANCE CORPORATION OF INDIA & ORS v. RAMAMANI PATRA & ANR, IV (2015) CPJ 529 (NC) izLrqr fd;kA bl U;k;n`"Vkar esa Hkh eku~uh; jk"Vªh; vk;ksx us chekjh ds rF; fNik;s tkus ij Dyse fujLr fd;k tkuk mfpr ekuk gSA 13- mijksDr ds izdk'k esas ;g ifjokn Lohdkj fd;s tkus ;ksX; ugha gksus ls fujLr fd;k tkrk gSA 14- mHk;i{k viuk&viuk okn O;; Lo;a ogu djsaxsA ¼,l-,l-caly½ ¼Mh-ds-JhokLro½ ihBklhu lnL; lnL;
e-iz-jkT; miHkksDrk fookn e-iz-jkT; miHkksDrk fookn izfrrks"k.k vk;ksx] Hkksiky izfrrks"k.k vk;ksx] Hkksiky xtsUnz 6 izdj.k Øekad lh-lh- % 53@2018 vjfoan iq= fo:) jsyhxs;j gsYFk ba';ksjsal dEiuh] fopkjkFkZ ¼,l-,l-caly½ ihBklhu lnL;
ekuuh; Jh Mh-ds-JhokLro % lnL;
¼fnuakd 27@07@2023 dks fu;r½
¼,l-,l-caly½
ihBklhu lnL;