State Consumer Disputes Redressal Commission
Star Health And Allied Insurance ... vs Mr. Mihir Singha Roy, Madya Badharghat, ... on 16 April, 2012
STATE
CONSUMER DISPUTES REDRESSAL COMMISSION,
TRIPURA
Appeal Case No.F.A-03/2012
Star
Health and Allied Insurance Company Ltd,
South Kolkata
Branch Office,
200/2/C, Rasbihari Avenue,
#rd Floor,
Kolkata-700029.
Star
Health and Allied Insurance Company Ltd,
KRM Centre, 6th
Floor,
2,
Harrington Road,
Chennai-600031.
. . .
. Appellants.
Vs
Mr. Mihir Singha Roy,
Madya Badharghat, Near Milan
Chakra Club.
P.S-West Agartala,
P.O-A.D.Nagar,
West
Tripura, Agartala.
Bajaj
Capital Insurance Broking Limited,
Agartala Branch Office,
B.K.Road, Palace Compound,
P.O-Agartala, West Tripura.
. .
. . Respondents.
PRESENT :
HONBLE
MR.JUSTICE A.B.PAL,
PRESIDENT,
STATE COMMISSION
MR.B.K.SHARMA,IAS (Retd),
MEMBER,
STATE
COMMISSION.
For the Appellants : Mr.U.K.Majumder, Adv.
For the Respondent : Mr. B.K.Bhattacharyya,Adv
Date of Hearing : 20-03-2012
Date
of delivery of Judgment : 16-04-2012.
J U D G M E N T
Pal,J , This appeal has arisen from the judgment dated 18-01-2012 passed by the Learned District Forum, West Tripura, Agartala in C.C-52 of 2011 whereby the appellant company has been directed to pay Rs.2,62,000/- only to the complainant-respondent Sri Mihir Singha Roy within 30 days from the date of judgment with interest.
2. The short fact leading to the present proceeding is that the complainant purchased from the appellant one medi-classic individual policy for Rs.2,50,000/- in the name of his daughter Miss Anindita Singha Roy for the period from 31-08-2010 to 30-08-2011. Bajaj Capital Insurance Broking Limited, the 2nd respondent herein being the corporate agent of the insurance-company received the premium from the complainant. In November 2010 he along with his daughter went to Chennai for her treatment in the Apollo Hospital. She was diagnosed Dorsal Scoliosis. She was admitted on 29-11-2010 and discharged on 06-12-2010 after surgery. He incurred expenditure of Rs.4,73,853.91 towards of her treatment. He made a claim for Rs.2,50,000/- from the insurer. But the claim was repudiated on the ground that the policy proposal did not mention that she was suffering from the disease. Aggrieved by the repudiation the complainant approached the District Forum which rendered the impugned judgment.
3. The only ground for repudiation is alleged suppression of the disease. Reliance was placed on General Information document about the patient by Dr. Madhan Mohan Reddy, Consultant Orthopaedician. General information shows that she went to the hospital with a complaint of deformity in back for four months. If the four months are counted, it would appear that she had this complaint before the insurance proposal by her father. The argument was that this amounted to material suppression.
4. We have heard learned counsel for the parties.
5. The general information issued by the hospital shows that the first consultation prior to hospitalization was on 24-11-2010 and the admission was on 29-11-2010. Dorsal Scoliosis was diagnosed only on 24-11-2010. She might have felt certain discomfort prior to that date without knowing particular disease. Her father also had no reason to know before the diagnosis that his daughter was suffering from that particular disease. Therefore, it can not be said that there was any suppression at the time of the insurance proposal. The complainant later obtained corrigendum from the Apollo Hospital stating that the general information about the complaint issued earlier should be read four weeks in place of four months. If the corrigendum is accepted the question of suppression would not arise. It has, however, been pointed out by the learned counsel for the appellant that the signature of Dr. Madhan Moham Reddy in the corrigendum is totally different from the signature on the general information sheet. Therefore, the corrigendum should not be accepted. Even if this corrigendum is not accepted as genuine, there is no difficulty to take the view that the disease was not known to the complainant or his daughter before the diagnosis in the Apollo Hospital on 24-11-2010 though she had certain discomfort without knowing the reason. We, therefore hold that it was not a material suppression in the policy proposal and the repudiation is illegal and arbitrary.
6. For the reasons aforementioned we do not find sufficient merit in this appeal. Consequently, the same is dismissed with cost of Rs.10,000/- payable by the appellant to the Legal Aid Account of this Commission within a period of one months from today.
MEMBER PRESIDENT State Commission State Commission Tripura Tripura