State Consumer Disputes Redressal Commission
Sarla Devi vs Bajaj Allianz Life Insurance Limited & ... on 11 September, 2013
H.P. STATE CONSUMER DISPUTES REDRESSAL COMMISSION,
SHIMLA.
First Appeal No.149/2013
Date of Presentation: 11.06.2013
Date of Decision: 11.09.2013
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Sarla Devi, wife of late Sh. Mandhar Lal Bedi alias Manohar
Lal Bedi,
Resident of Vivek Nagar, Peer Nigah Road, Una,
District Una, Himachal Pradesh.
.......... Appellant
Versus
(1) Bajaj Allianz Life Insurance Company Limited,
Jeevan Market, 2nd Floor, Una,
District Una, H.P.,
Through its Branch Manager.
(2) Medicare TPA Services (1), Private Limited, 6,
Bishop Lefroy Road, Kolkata-700 020.
.......... Respondents
..........................................................................................
Coram
Hon'ble Mr. Justice (Retd.) Surjit Singh, President
Hon'ble Mr. Chander Shekhar Sharma, Member
Hon'ble Mrs. Prem Chauhan, Member
Whether approved for reporting?1
For the Appellant: Mr. Ramesh Sharma, Advocate
For the Respondent No.1: Mr. Jagdish Thakur, Advocate
For the Respondent No.2: Ex-parte
..........................................................................................
O R D E R:
Justice (Retd.) Surjit Singh, President (Oral) Appellant has preferred this appeal, under Section 15 of the Consumer Protection Act, 1986, against the order dated 02.05.2013, of learned District Consumer Disputes Redressal Forum, Una, whereby her complaint, under Section 12 of the Consumer 1 Whether Reporters of the local papers may be allowed to see the order? {(Sarla Devi Vs. Bajaj Allianz Life Insurance Co. Ltd. & Anr.) (F.A. No.149/2013)} _____________________________________________________________ Protection Act, 1986, which she filed against the respondents, has been dismissed.
2. Appellant purchased a Health Care Policy from the opposite parties, which was effective from 28.03.2008 to 28.03.2011. In the month of July, 2009, she fell sick and was admitted to BBC Heart Care Pruthi Hospital, Lajpat Nagar, Jalandhar, on 02.08.2009. She was diagnosed to be suffering from Coronary Artery Disease. She then went to Fortis Hospital, Mohali and took treatment.
3. Claim was lodged with the opposite parties for reimbursing the expenses, in terms of policy purchased from them. Respondents turned down her claim. She, therefore, filed a complaint, under Section 12 of the Consumer Protection Act, 1986, seeking issuance of a direction to the opposite parties to pay claim and also to pay compensation and litigation expenses.
4. Opposite parties contested the complaint and pleaded that at the time of purchasing policy, appellant filled in a proposal form, in which, she answered, at-least one poser falsely and thus, she was guilty of suppression of material facts, with regard to Page 2 of 4 {(Sarla Devi Vs. Bajaj Allianz Life Insurance Co. Ltd. & Anr.) (F.A. No.149/2013)} _____________________________________________________________ her state of health and had she disclosed the true state of her health, respondents might not had entered into the contract of insurance.
5. Learned District Forum, accepting the respondents' plea dismissed the complaint.
6. We have heard learned counsel for the parties and gone through the record.
7. Proposal form that was filled in by the appellant is Annexure R-I. Vide poser 14 (b), appellant was required to state, whether she had any disease or disorder of cardiovascular system such as, chest pain, heart disease, high/low blood pressure, artery or blood disease. She answered the poser in negative. However, when she was admitted to Fortis Hospital, Mohali, the history which she gave out was that she had been having chest pain on exertion for the last few years. That means she had been having chest pain on exertion for several years, at the time of taking treatment at Fortis Hospital, but in the proposal form filled in by her, only one year prior to that, she specifically denied that she had been having chest pain.
Page 3 of 4 {(Sarla Devi Vs. Bajaj Allianz Life Insurance Co. Ltd. & Anr.) (F.A. No.149/2013)} _____________________________________________________________
8. Learned counsel representing the appellant submits that in the hospital, it was stated that appellant was having chest pain only on exertion, but in the proposal form, poser is not to the effect, whether she had chest pain on exertion. Submission has been noticed only to be rejected. When she was having chest pain, whether, on exertion or without exertion, she ought to have revealed this fact, while answering the relevant poser.
9. In view of the above stated position, appeal is dismissed.
10. A copy of this order be sent to each of the parties, free of cost, as per Rules.
(Justice Surjit Singh) President (Chander Shekhar Sharma) Member (Prem Chauhan) Member September 11, 2013 *dinesh* Page 4 of 4