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State Consumer Disputes Redressal Commission

Life Insurance Corporation Of India, vs Shri.Dagadu Sitaram Mahale on 12 October, 2009

                                    1                         F.A.No. :2144/04



                               Date of filing:23.11.2004
                               Date of order:12.10.2009
MAHARASHTRA STATE CONSUMER DISPUTES REDRESSAL
COMMISSION, MUMBAI, CIRCUIT BENCH AT AURANGABAD.

F.A. NO.: 2144 OF 2004
IN COMPLAINT CASE NO. : 2144 OF 2004
DISTRICT FORUM : DHULE.

1.    Life Insurance Corporation of India,
      Dondaicha Branch Office,
      Tq.Sindkheda, Dist.Dhule.

2.    Life Insurance Corporation of India,
      Nashik Divisional Office,
      Golf Club Ground,
      Nashik.
      Through
      Life Insurance Corporation of India,
      Western Zonal Office,
      Yogakshema, Jeevan Bima Marg,
      Mumbai 400 021.                                 ...APPELLANTS
                                                      (Org.Opponents)
VERSUS

Shri.Dagadu Sitaram Mahale,
Residing at Asane, Post Nhyahali,
Tq.Nandurbar, Dist.Nandurbar.                        ...RESPONDENT
                                                    (Org.Complainant)
            Coram :      Shri.S.G.Deshmukh, Hon`ble Presiding Judicial
                         Member.

Mrs.Uma S.Bora, Hon`ble Member.

Present : Adv.Shri.Narwadkar holding Adv.Shri.Murar Deshpande for appellant, Adv.Shri.V.P.Bhamare for respondent.

O R A L O R D E R Per Shri.S.G.Deshmukh, Hon`ble Presiding Judicial Member.

1. The present appeal is filed by L.I.C.of India against the judgment and order dated 18.08.2004 in complaint case No. 15/02 passed by District Forum, Dhule.

2. Respondent/Org.Complainant`s case before the Forum is that, he had taken Ashadeep Policy for sum assured of Rs.50,000/- from appellant for the period 28.11.95 to 28.11.2015. It is contended that complainant had undergone 'Mitral Valve replacement' in J.J.Hospital, Mumbai. Complainant submitted the claim for policy amount. The claim was repudiated on the ground that operation performed on the complainant for replacement of Mitral Valve is not covered under Ashadeep Policy. Thus he approached the Forum.

3. The present appellant appeared before the Forum and resisted the claim. It is contended that replacement of Mitral Valve is not covered under Ashadeep plan thus they have rightly repudiated the claim.

4. The Forum below after going through the papers and hearing the parties allowed the complaint and directed appellant to pay policy amount as per rules within a month. Forum also directed to pay Rs.1000/- towards mental agony and Rs.500/- towards cost within a month. Forum directed if the amount of policy and mental agony is not paid within prescribed period it shall carry interest @ 8% p.a.

5. Being aggrieved by the said judgment and order passed by the District Forum, Dhule, L.I.C. of India came in appeal.

6. Notices were issued to the appellants as well as respondent. Learned counsel Shri.Murar Deshpande had appeared on behalf of appellant. Learned counsel Shri.Bhamare appeared on behalf of respondent. We heard learned counsel Shri.Narwadkar holding for Adv.Shri.Deshpande for the appellant and learned counsel Shri.Bhamare for respondent. Learned counsel Shri.Narwadkar submitted that 3 F.A.No. :2144/04 replacement of Mitral Valve is not covered under the policy. The Forum below erred in allowing the complaint.

7. On the other hand learned counsel Shri.Bhamare submitted that Forum has rightly allowed the complaint. He relied on 'Senior Branch Manager, LIC of India -Vs- Vemuri Rangaiah' reported in I(2004) CPJ 545 ( A.P.State Consumer Dispute Redressal Commission, Hyderabad).

8. We perused the papers and gave our anxious thoughts to the arguments advanced by both the counsels. There is no dispute that respondent/org.complainant had taken Ashadeep policy for sum assured of Rs.50,000/-. There is also no dispute that during the period of policy complainant had undergone replacement of Mitral Valve in J.J.Hospital, Mumbai. The operation was carried by Ddr.K.M.Bhosale. On perusal of policy it reveals that policy excludes certain procedure which are usually done by the Cardiologist while the open heart surgery is performed by Cardio Thorasic Surgeon. Valve replacement is not specifically mentioned in Exclusion Clause. The Forum below has rightly considered the ratio in Vemuri Rangaiah`s case(Supra) and rightly allowed the complaint. We are not inclined to interfere the order passed by the Forum. We pass the following order.

                                   O   R       D   E   R


     1.     Appeal is dismissed.
     2.     No order as to cost.
     3.     Pronounced and dictated in the open court.

4. Copies of the order be sent to both the parties.

Mrs.Uma S.Bora                                   S.G.Deshmukh,
     Member                                Presiding Judicial Member
        4   F.A.No. :2144/04




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