State Consumer Disputes Redressal Commission
Icici Prudential Life Ins. Co. vs Smt Yashika @ Meera on 16 January, 2015
jkT; miHkksDrk fookn izfrrks"k vk;ksx] cSap la- 3 t;iqj ¼jkt-½ vihy la- 1358@2012 ICICI Prudential Life Ins. Co. cuke Jherh ;kf'kdk mQZ ehjk fu.kZ; fnukad % 16&01&2015 le{k % ek- ihBklhu lnL; % Jh vfuy dqekj feJk ek- lnL; %Jh dSyk'k lks;y mifLFkr % vihykFkhZ % Jh jkds'k dqekj jtokfu;ka ,MoksdsV A jsLikMsaVl~ % Jh jkts'k ewFkk ,MoksdsV A ;g vihy foi{kh@vihykFkhZ us fo)ku ftyk eap vyoj ds ifjokn la- 1199@2010 esa ikfjr vkns'k fnukad% 13&9&2010 ls O;fFkr gksdj is'k dh gS] ftlds )kjk ifjoknhx.k dk ifjokn fuEu izdkj Lohdkj fd;k x;k Fkk %& vr% vkns'k fn;k tkrk gS fd foi{khx.k chek dEiuh vkt ls ,d ekg esa ifjoknhx.k dks chek Dyse jkf'k 8]00]000@& :- e; 9 izfr'kr C;kt fnukad% 3&1&2008 ls rFkk ifjoknhx.k dks gq, ekufld larki dh {kfriwfrZ ,oa ifjokn O;; ds :i esa 5]000@&:- vnk djsxh A fu/kkZfjr vof/k ,d ekg esa mDr jkf'k vnk ugha djus ij ifjoknhx.k foi{khx.k ls mDr leLr jkf'k ij fu.kZ; fnukad ls rkvnk;xh rd 15 izfr'kr okf"kZd nj ls C;kt izkIr djus dh vf/kdkjh gksx a sA &2& la{ksi esa izdj.k ds rF; bl izdkj gSa fd ifjoknhx.k ds ifr o firk ;'kdqekj dqdjspk us vius thoudky esa foi{khx.k ls ,d thou chek ikWfylh dherh ikap yk[k :i;s dh LoLFk tkap izfØ;k ds rgr esMhdy tkap djokus ds ckn yh] rFkk nwljh chek ikWfylh rhu yk[k :i;s dh yh Fkh A chek/kkjh dks ihfy;k gksus ls mldk yhoj Msest gks x;k rFkk fn% 3&1&2008 dks mldh e`R;w gks x;h A ftldh lwpuk rqjUr chek dEiuh dks nh o vko';d vkSipkfjdrk;sa iw.kZ dj Dyse is'k fd;k A ysfdu chek dEiuh us Dyse ugha fn;k A fn% 4&10&2010 dks tkudkjh djus ij chek Dyse nsus ls bUdkj dj fn;k A vr% ifjoknhx.k us Dyse jkf'k vkB yk[k :- e; C;kt o vU; gtkZuk fnyok;s tkus ckcr ftyk eap ds le{k ifjokn is'k fd;k A foi{kh us ftyk eap ds le{k ifjokn dk tcko izLrqr dj tkfgj fd;k fd chek/kkjd dk csfld esMhdy VsLV djk;k x;k o mlls LokLF; lEcU/kh iz'u iwNs x;s Fks A csfld esMhdy VsLV esa xEHkhj chekjh dks Vªsl ugha fd;k tk ldrk A chek/kkjh us chek izLrko esa lgh rF; vafdr ugha djrs gq, viuh chekjh ds rF;ksa dks fNik;k A chek/kkjd dh e`R;w fn% 3&1&2008 dks Illness ds dkj.k gqbZ Fkh] lkFk gh esMhdy fgLVªh ds vUrxZr Illness-Joindis crk;k x;k Fkk A foi{khx.k )kjk vuql/a kku djkus ij chek/kkjd mDr chek ikWfylh ysus ls iwoZ nks o"kksZa ls yxkrkj 'kjkc o /kweziku dk lsou dj jgk Fkk A mldh e`R;w Alcoholic Liver Disease. Gastrointestinal Bleed. Jaundice and Cholelithiasis ds dkj.k gqbZ Fkh A bl izdkj e`rd chek/kkjh )kjk chek izLrko esa viuh chekjh dks fNikus ds dkj.k foi{khx.k chek dEiuh )kjk ifjoknhx.k dk chek Dyse lgh :i ls [kkfjt fd;k x;k gS A ifjoknhx.k dk ifjokn [kkfjt fd;k tkos A geus mHk; i{k dh cgl lquh rFkk i=koyh ij miyC/k lkexzh dk voyksdu fd;k A &3& fo)ku ftyk eap us foLr`r fooj.k nsrs gq, leqfpr vkns'k ikfjr fd;k gS ftlesa ge gLr{ksi djus dk dksbZ dkj.k ugha ikrs gSa A chek dEiuh us chek/kkjd )kjk va'kqeku vLirky esa djk;s x;s bykt ds nLrkostkr izLrqr fd;s gSa oks fnukad% 6&12&2007 rFkk mlds ckn ds gSa tks chek/kkjd )kjk ikWfylh ysus ds ckn ds gSa A blds vykok va'kqeku vLirky ds vU; izsfLØI'ku is'k fd;s x;s gSa mu ij dksbZ rkjh[k Mkyh gqbZ ugha gS A bl nLrkostkr ;s Li"V gksrk gS fd e`rd chek/kkjh Joindis dh chekjh ls ihfM+r Fkk A pwfa d bykt ds lHkh nLrkostkr e`rd chek/kkjh )kjk mDr chek ikWfyfl;ka ysus ds ckn ds gSa] blls e`rd chek/kkjh us chek izLrko esa viuh chekjh ds rF;ksa dks fNik;k gks ;g rF; foi{kh lkfcr ugha dj ik;s gSa A chek/kkjd )kjk 'kjkc lsou o /kweziku djus ds lEcU/k esa chek dEiuh dh vksj ls fdlh MkDVj 'kiFk i= is'k ugha fd;k x;k gS A blfy, ;g ugha ekuk tk ldrk fd chek/kkjd 'kjkc ihus o /kweziku djus dk vknh Fkk A vr% vihykFkhZ dh vihy lkjghu gksus ls [kkfjt fd;s tkus ;ksX; gS A ifj.kker% ftyk eap vyoj ds ifjokn la- 1199@2010 esa ikfjr vkns'k fnukad% 13&9&2012 dh iqf"V djrs gq, vihykFkhZx.k dh vihy [kkfjt dh tkrh gS A eap vkns'k dh ikyuk ds fy, vihykFkhZx.k dks 30 fnol dk le; fn;k tkrk gS A eap vkns'k dh ikyuk gksus ij vihykFkhZx.k )kjk tek djok;h x;h jkf'k e; vftZr ykHk ds mUgsa okil ykSVk nh tkos A lnL; ihBklhu lnL;
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