State Consumer Disputes Redressal Commission
Surender Bansal vs National Insurance Co. Ltd. on 1 May, 2014
IN THE STATE COMMISSION : DELHI (Constituted under Section 9 of the Consumer Protection Act, 1986) Date of Decision: 01.05.2014 First Appeal No. 636/13 (Arising from the order dated 26.04.2013 passed by District Forum {North}, Tis Hazari, Delhi in Complaint Case No. 341/2010) Surender Bansal B-FH-125, Shalimar Bagh (West) Delhi - 110088 Appellant Vs 1. National Insurance Co. 30-31, A, Asaf Ali Road, New Delhi 110002 2. Alankit Health Care Ltd. 2-E/21, Jhandewalan Ext. New Delhi - 110055 .. Respondent Coram Salma Noor, Presiding Member
N P Kaushik, Member (Judicial)
1. Whether reporters of local newspaper be allowed to see the judgment?
2. To be referred to the reporter or not?
N P Kaushik, Member (Judicial)
1. Present appeal is directed against the impugned orders dated 26.04.2013 passed by Consumer Disputes Redressal Forum, North (in short District Forum). Vide its order the District Forum directed the complainant/appellant to approach the OP/Respondent and produce the documents relating to the actual nature of ailment, its history and treatment taken by his wife. OP was directed to decide the claim within a period of 30 days.
2. Facts in brief are that the complainant/appellant was enjoying a medical policy for himself, his daughter Ms. Vanshika Bansal and his wife Mrs. Bharti Bansal. Wife of the complainant was admitted to Arvind Eye Hospital, Anne Nagar, Mudurai. She was operated upon on 19.07.2008 and discharged on 24.07.2008. An amount of Rs. 16,753/- was spent by the patient. Claim was repudiated by the OP on the grounds that his wife was treated for post lasik ectasia of both the eyes and the same was not covered under clause 4.6 of the policy. Ld. District Forum observed that the beneficiary was suffering from eye problems and had undergone lasik surgery, a corrective surgery. Reimbursement of amount spent on corrective surgery was not permissible. It was also observed by the Ld. District Forum that the complainant was guilty of concealment of material facts.
3. Be that as it may, the beneficiary had undergone lasik surgery, a corrective surgery. The treatment taken by her in Arvind Eye Hospital, Anne Nagar, Mudurai clearly related to post lasik ectasia. Question of post lasik ectasia arose only when the beneficiary had undergone lasik surgery. It is not the case of the complainant that she ever disclosed having undergone lasik surgery. She concealed the material facts. She is not entitled to the claim for the reasons that the amount spent on corrective surgery is not admissible and secondly she concealed the material information. Ld. District Forum has though not arrived at a definite conclusion, it had directed the complainant to approach the insurance company with relevant documents and satisfy that the treatment undergone by his wife prior to taking the policy did not pertain to lasik surgery and the subsequent treatment did not pertain post lasik ectasia. The complainant appears to be avoiding the directions of the District Forum.
4. With aforesaid observations we are of the considered opinion that the appeal is devoid of merits. The same is dismissed
5. FDR/Bank Guarantee, if any, furnished by the appellant be returned forthwith after completion of due formalities.
6. A copy of this order as per the statutory requirements, be forwarded to the parties free of costs and also to the concerned District Forum and thereafter the file be consigned to Record Room.
(Salma Noor) Presiding Member (N P Kaushik) Member (Judicial) NV