State Consumer Disputes Redressal Commission
The New India Assurance Co.Ltd. vs Dr.Anilkumar H.Mathia And Another on 10 July, 2009
CONSUMER DISPUTES REDRESSAL COMMISSION CONSUMER DISPUTES REDRESSAL COMMISSION MAHARASHTRA STATE, MUMBAI FIRST APPEAL NO.1222/2007 Date of filing: 01/10/2007 IN CONSUMER COMPLAINT NO.177/2005 Date of order : 10/07/2009 DISTRICT CONSUMER FORUM, MUMBAI SUBURBAN @ MISC.APPPLICATION NOS.1659 & 1660/2007 The New India Assurance Co.Ltd. D.O.no.112700 Jeevan Sahakar Building Sir Phirozshah Mehta Road Fort, Mumbai 400 093 ..Appellant/org.O.P.no.1 v/s. 1. Dr.Anilkumar H.Mathia A-4 Arihant Co-op.Hsg.Society Opp.Damodar wadi, Ashok Chakravarty Road Kandivali(E), Mumbai 400 401 Respondent/org.complainant 2.M/s.TTK Health Care Services Pvt.Ltd. 202 Mehta Estate, 2nd floor Andheri Kurla Road Mumbai 400 093 Respondent/org.O.P.no.2 Corum: Shri S.R.Khanzode, Honble Presiding Judicial Member
Smt.S.P.Lale, Honble Member Present : Mrs.Urmila Sanil-Advocate for the appellant.
Mrs.Anita Marathe-Advocate for the respondent no.1 None for respondent no.2 O R D E R Per Shri S.R.Khanzode, Honble Presiding Judicial Member
1. We heard Mrs.Urmila Sanil-Advocate for the appellant. Mrs.Anita Marathe-Advocate for the respondent no.1. None for respondent no.2. Perused the record.
2. There is delay of 43 days in filing the appeal and therefore applicant/ appellant has preferred misc.application no.1659/2007 for condonation of delay. The statement explaining the delay reads as under:-
The impugned order was passed on 29/6/2007 the certified copy was received by the Appellants advocate on 18/7/2007. She conveyed the certified copy to underwriting office on 28/7/2007. Who immediately sent the papers to Regional office Mumbai to file appeal. The regional office at Mumbai send the papers by post to this advocate. The Advocate received the same on about 16/8/2007. It took some time to prepare the appeal. Therefore there is delay of days in filing the present appeal.
3. Neither in the application for condonation of delay nor the supporting affidavit for the said application sworn by one Mr.B.N.Prasad, Regional Manager, dated 29/9/2007 explained as to when the lawyer was instructed to file the appeal. Thus, important circumstances and facts are suppressed. Vagueness in the statement explaining the delay drive it in the category of unexplained delay. Delay being not satisfactorily explained, application for condonation of delay deserves to be dismissed. We hold accordingly and dismiss the application for condonation of delay. However by way of abundant precaution we also looked into merits of the appeal.
4. This appeal arises out of order/award dated 29/6/2007 passed in consumer complaint no.177/2005 Mr.Anilkumar H.Mathia v/s. The Divisional Manager, New India Assurance Co. Ltd. and another passed by Mumbai Suburban District Consumer Forum. Insurance mediclaim against hospitalization of Rs.1,25,785/- made by respondent no.1/org.complainant stood rejected by the appellant /O.P.no.1/ Insurance Co. and feeling aggrieved thereby, complainant had to file a consumer complaint, which stood decreed as per impugned order/award and feeling aggrieved thereby, O.P.no.1-Insurance Co. has preferred this appeal. There appears to be no appeal preferred by respondent/O.P.no.2-M/s.TTK Health Care Services Pvt.Ltd., who is hold jointly and severally held responsible to pay the decreetal dues.
5. In the instant case, referring to the history of chewing of tobacco and Gutkha for about 25 years as mentioned in the discharge card/summary issued by Leelavati Hospital and Research Centre, wherein the complainant was admitted, the claim was rejected/repudiated referring to clause no.4.8 of the Mediclaim Insurance Policy. Said clause 4.8 which relates to exclusion clause reads as under:-
Convalescence general debility, Run-down condition or rest cure, congenital external disease or defects or anomalies, sterility, venereal disease, intentional self injury and use of intoxicating drugs/alcohol.
6. According to appellant long standing habit of chewing tobacco and Gutkha bound to lead to oral cancer and thus it would fall within the description of intentional self injury and, therefore, covered under the exclusion clause 4.8, supra. We are unable to agree with the submissions in absence of any evidence on record. Many people chew tobacco and Gutkha, but that does not necessarily will lead to oral cancer. Tobacco chewing is also advertised as injurious to health. But that does not mean that it is the cause and only cause for the alignment suffered by the complainant. It also cannot be stated that he had suppressed any information regarding his alignment for which he was hospitalized, when the mediclaim insurance policy was taken. Under the circumstances, rejection/repudiation of the mediclaim of the complainant was improper and appellant/O.P.no.1 Insurance Co. miserably failed to justify their such repudiation/rejection. Forum below rightly held so. Accordingly we find no reason to take a different view. Thus, we find appeal devoid of any substance on merits also.
ORDER
1. Misc. application for condonation of delay stands rejected.
2. Appeal stands dismissed.
3. Appellant to bear its own cost and pay Rs.1000/- as cost to respondent/org. complainant.
4. Misc.application for stay stands disposed of as infructuous.
5. Copies of the order be furnished to the parties.
(S.P.Lale) (S.R.Khanzode) Member Presiding Judicial Member Ms.