State Consumer Disputes Redressal Commission
The Oriental Insurance Company Ltd vs Rajesh Kantkar on 22 January, 2015
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KYNM O NHN = @ Y ^ N vihykFkhZ@vukonsd us ;g vihy /kkjk&15 miHkkDsrk lja{k.k vf/kfu;e] 1986] ds vraxZr ftyk miHkkDsrk fookn izfrrk"sk.k Qksje] jk;iqj ¼N-x-½ ¼ftls vkxs lfa{kIr eas **ftyk Qksje** lackfs/kr fd;k tk,xk½ ds ifjokn izdj.k dzekd a &202@2013 jkt'sk dVadkj fo:n~/k fn // 2 // vkfsj,Vay ba';ksjsl a daiuh fyfeVM s eas ikfjr vkn'sk fnukd a &14-07-2014 ftlds }kjk mRrjoknh@ifjoknh dk ifjokn Lohdkj djrs gq, ;g vknfs'kr fd;k x;k gS fd%& **v- vukonsd] ifjoknh dks fpfdRlk dkfjr O;; 1]00]000@&¼,d yk[k :Ik;½s ifjokn fnukad&10-05-2013 ls vnk;xh fnukd a rd 18 izfr'kr lk/kkj.k okf"kZd C;kt lfgr vnk djx s kA c- vukonsd] ifjoknh dks mijkDsr d`R; ds dkj.k gqbZ vkfFkZd o ekufld d"V ds fy, 25]000@&¼iPphl gtkj :Ik;½s vnk djx s kA l- vukonsd] ifjoknh dks vf/koDrk 'kqYd rFkk oknO;; ds :Ik eas 10]000@&¼nl gtkj :Ik;½s Hkh vnk djx s kA** ls nqf[kr gkd s j izLrqr fd;k gSA 02- mRrjoknh@ifjoknh dk ifjokn ftyk Qkjse ds le{k lfa{kIr esa bl izdkj gS fd mRrjoknh@ifjoknh us Lo;a o vius ukfer dh LokLF;xr lqj{kk ,oa Hkfo"; eas LokLF; lcaa/kh fgrkas dks lajf{kr djus grsq vihykFkhZ@vukonsd }kjk cgq izpkfjr] izlkfjr ;qfuolZy gsYFk b'a;kjssal ikWfylh dzekd a &152300@47@2009@157 fof/kor~ izhfe;e vnk dj izkIr dh Fkh tks fd fnukd a &24-11-2008 ls fnukd a &23-11-2009 rd dh vof/k ds fy, FkkA ikWfylh vof/k eas mRrjoknh@ifjoknh }kjk fdlh Hkh izdkj dk dkbsZ Hkh nkok vihykFkhZ@vukonsd ds le{k izLrqr ugha fd;k x;k Fkk rFkk mRrjoknh@ifjoknh us mDr ikWfylh dks fu/kkZfjr izhfe;e vnk dj uohuhdj.k djok;k Fkk ftldk ikWfylh dzekd a &191100@47@ 2010@281 fnukd a &24-11-2009 ls fnukd a &23-11-2010 iznku dh FkhA blh izdkj mDr ikWfylh dks iqu% uohuhdj.k djrs gq, ikWfylh dzekd a &191100@47@2011@180 fnukd a &18-11-2010 ls fnukd a & 17- 11- // 3 // 2011 iznku dh xbZ FkhA o"kZ 2012 eas vihykFkhZ@vukonsd }kjk mRrjoknh@ifjoknh dks lykg nh xbZ fd mRrjoknh@ifjoknh dh 'kUw; nkok i`"BHkfwe dks ns[krs gq, mRrjoknh@ifjoknh ds fy, mDr ikWfylh dh ctk; gSih Qfseyh Q~yksVj ikWfylh ysuh pkfg, ftlls mRrjoknh@ifjoknh ,oa mlds ukfer dks vPNh fpfdRlk lqj{kk ,oa fjLd doj izkIr gkx s kA fygktk mRrjoknh@ifjoknh us mDr gsrq fu/kkZfjr izhfe;e jkf'k dk Hkqxrku dj gSih Qfseyh Q~yksVj ikWfylh dzekd a &191100@48@2012@2825 fnukd a &30-03-2012 ls fnukd a & 29- 03- 2013 izkIr dh FkhA fnukd a &20-01-2013 dks mRrjoknh@ifjoknh ds lhus eas vpkud rt s nnZ gksus ds dkj.k mls jked`".k gkWfLiVy jk;iqj eas xgu fpfdRlk grsq HkrhZ gkusk iMk+ v k Sj fnukd a &25-01-2013 dk s mRrjoknh@ifjoknh dks vLirky ls fMLpktZ dj fn;k x;kA mRrjoknh@ifjoknh dk s vius fpfdRlh; mipkj grsq yxHkx 1]00]000@&¼,d yk[k :Ik;½s dk O;; mBkuk iMk+ Fkk ftldh izfrifwrZ grsq vihykFkhZ@vukonsd ds funZs'kkuqlkj nkok izi= leLr vko';d nLrkot s ksa lfgr vihykFkhZ@vukonsd ds le{k izLrqr fd;k x;k Fkk ftls vihykFkhZ@vukonsd }kjk cukoVh] eux<ra ,oa cxSj fdlh mfpr vk/kkj ds lia.wkZ :Ik ls fujLr dj fn;k x;k gS tks fd vihykFkhZ@vukonsd dh losk eas xHakhj fuEurk ,oa dnkpj.k dk d`R; gSA mRrjoknh@ifjoknh }kjk vihykFkhZ@vukonsd ls izkIr mDr ikWfylh dh oS/krk fnukd a &29-03- 2013 dks lekIr gksus okyh Fkh ftls ns[krs gq, vihykFkhZ@vukonsd us mRrjoknh@ifjoknh ls fu/kkZfjr izhfe;e jkf'k izkIr dj mDr ikWfylh dk uohuhdj.k dj fn;k gS ftldk ikWfylh dzekd a &191100@48@2013@ 2905 ,oa oS/krk vof/k fnukd a &30-03-2013 ls fnukd a &29-03-2014 rd gSA mRrjoknh@ifjoknh }kjk izLrqr izFke fpdRlk O;; nkos dk s mRrjoknh@ifjoknh dks iwoZ ls jkx s xzLr gksus dk fujk/kkj dkj.k crkrs gq, fujLr dj fn;k tkuk lsok eas xHakhj fuEurk ,oa dnkpj.ki.wkZ d`R; gSA // 4 // mRrjoknh@ifjoknh }kjk vihykFkhZ@vukonsd dks lp w uk i= izfs"kr dj nkok jkf'k dh ekx a dh xbZ Fkh fdUrq vihykFkhZ@vukonsd }kjk fujFkZd tokc Hkt s dj mRrjoknh@ifjoknh ds mfpr nkos dks vekU; dj fn;k x;k gS tcfd iowZ eas vihykFkhZ@vukonsd }kjk tkjh ikWfyfl;ksa dh oS/krk ds nkSjku dkbsZ nkok izLrqr ugha fd;k x;k Fkk ftlls Li"V gS fd mRrjoknh@ifjoknh dks LokLF; lac/akh dkbsZ ij'skkuh iowZ vFkok nkokd`r ikWfylh izkIr djrs le; ugha FkhA vr% mRrjoknh@ifjoknh dks ifjokn&i= eas of.kZr vuqlkj vuqrks"k fnykbZ tkoAs 03- vihykFkhZ@vukonsd us ftyk Qkjse ds le{k fyf[kr dFku izLrqr dj ;g vfHkopu fd;k gS fd mRrjoknh@ifjoknh us Lor% vius foosd ls gSIih Qfseyh Q~yksVj ikWfylh 'kM s ~;y w ds rgr mlds ,oa vU; nks ikfjokfjd lnL; ds fy, izkIr fd;k gS ftls chek ikWfylh dzekd a &191100@48@2012@2825 ds rgr lia.wkZ fu;ekoyh ds lkFk vihykFkhZ@vukonsd }kjk mRrjoknh@ifjoknh dks iznku fd;k gS ftldh vof/k fnukd a &30-03-2012 ls fnukd a &29-03-2013 rd gS vkSj ;g ikWfylh uohu ikWfylh gS vkSj mDr uohu ikWfylh ls iowZ vU; ikWfylh izkIr fd;s tkus lac/akh ckrkas dk lcaa/k bl izdj.k ls ugha gS vkSj ubZ ikWfylh dh 'krZsa gh mRrjoknh@ifjoknh ij c/akudkjh gS ftlds ,DlDyt w u DykWt 4-3 eas ;fn nks lky igys rd gkbZijV'asku vkSj nks lky igys ls Mk;fcVht gks rks ,DlDyt w u DykWt ,IykbZ gkx s k vkSj ;fn chfer jde iowZ ikWfylh ds ckn c<+kbZ tkrh gS rks ,DlDywtu DykWt 4-1] 4-2 ,oa 4- 3 ckn dh fLFkfr esa ykxw gkx as s vkSj chek /kkjd }kjk ikWfylh izkIr djus ds nks o"kZ ds Hkhrj ;fn gkbZijVas'ku vkSj Mk;fcVht ds bZykt ls lacaf/kr O;; dk nkok fd;k tkrk gS rks vihykFkh@ Z vukosnd dk nkf;Ro ugha cux s kA mRrjoknh@ifjoknh ds nkos ls lacfa/kr nLrkot s ,oa chek ikWfylh] mDr ikWfylh eas vraZfufgr fo'y"skd FkMZ ikVhZ ,MfefuLVªsVj dks // 5 // fHktok;k x;k D;kfasd vkbZ- vkj- Mh- ,- ds fn'kk&funZs'k ,oa chek vgZrkvkas ds ifjiz{s; esa efsMDyes ls lacfa/kr nkokas dk fujkdj.k FkMZ ikVhZ ,MfefuLVªsVj }kjk fd;k tkrk gS tks vkbZ- vkj- Mh- ,- ls vuqKfIr/kkjh gkd s j ukfer gksrs gS]a vr,o mRrjoknh@ifjoknh ds lia.wkZ fpfdRldh; nLrkot s ] nkok izi= ,oa vU; dkxtkr mDr Vh- ih- ,- dks fHktok;s x;s Fks ftUgkusas lai.wkZ rF;ksa dh foop s uk djus ds ckn ;gh fu/kkZfjr fd;k x;k fd ,DlDyt w u DykWt 4-3 ds vuqlkj nkok Lohdkj ;ksX; ugha gS ftlds lcaa/k esa mRrjoknh@ifjoknh dks i= fnukd a &28-03-2013 dks lfwpr dj fn;k x;k FkkA mRrjoknh@ifjoknh }kjk izfs"kr i= izkIr gksus ij vf/koDrk ds ekQZr~ lwpuk&i= fnukd a &30-04-2013 izfs"kr djokdj lia.wkZ rF;xr ckrksa ls voxr djok;k x;k fd mUgas ikWfylh ds rgr {kfrifwrZ ikus dh ik=rk ugha gSA mRrjoknh@ifjoknh ds nkos dk fujkdj.k leqfpr vk/kkj ij djrs gq, chek viotZuk ds rgr mudk nkok gksus ds dkj.k {kfrifwrZ djus ds fy, ftEenskj u gksus ls nkos dks fujLr djus dh dk;Zokgh dj mldh tkudkjh ls mRrjoknh@ifjoknh i{k dks voxrdjk fn;k gSA mRrjoknh@ifjoknh dkbsZ Hkh jkf'k ikus dh ik=rk ugha j[krk gSA vr% mRrjoknh@ifjoknh dk ifjokn lO;; fujLr fd;k tkoAs 04- mHk;i{k }kjk izLrqr nLrkot s h lk{;kas ds ifj'khyu Ik'pkr~ ftyk Qkjse us ifjoknh ds ifjokn dks Lohdkj djrs gq, Åij dfaMdk&1 eas of.kZr vuqlkj vuqrk"sk iznku fd;k gS ftlds fo:n~/k ;g vihy gSA 05- mRrjoknh@ifjoknh dh vkjs ls vius i{k leFkZu eas ftyk Qksje ds le{k Happy Family Floater Policy schedule (Annexure-1)] Dyes QkeZ fnukd a &18-02-2013 (Annexure-2)] mRrjoknh@ifjoknh dk nkok vLohd`fr i= fnukd a &28-02-2013 (Annexure-3)] mRrjoknh@ifjoknh dk i= // 6 // fnukd a &18-04-2013 (Annexure-4)] Universal Health Insurance Policy Schedule fnukd a &24-11-2008 ls 23-11-2009 ( Annexure-5)] Universal Health Insurance Policy Schedule fnukd a &24-11-2009 ls 23-11-2010 ( Annexure-6)] Universal Health Insurance Policy Schedule fnukd a &18-11- 2010 ls 17-11-2011 (Annexure-7)] nkok lp w uk fnukd a &21-01-2013 (Annexure-8)] vVUsMsaV dkMZ (Annexure-9)] bdks dkfMZ;kx s zkfQd fjiksVZ fnukd a &21-01-2013 (Annexure-10)] ,e-vkj-vkbZ- ,oa ,fat;ksxzkQh (Annexure-11) rFkk fcy lejh ,oa fcy (Annexure-12) dh QksVks dkih izLrqr fd;k gSA 06- vihykFkhZ@vukonsd dh vkjs ls vius i{k leFkZu eas ftyk Qksje ds le{k Happy Family Floater Policy e; 'krZ ( Annexure-1)] efsMDyes ikWfylh Dyes QkeZ fnukd a &18-02-2013 ( Annexure-2)] fMLpktZ lejh fnukd a &25-01-2013 ( Annexure-3)] MkbZVjh fMikVZeVas dk vkgkj rkfydk ( Annexure-4)] ckW;kd s essLVªh VsLV fjikVsZ fnukd a &21-01-2013 (Annexure-5 7
6)] MkW- lt a ; 'kekZ dk fizlfdzI'ku fLyi fnukad&12-02-2013 ( Annexure-
7)] MkfYQu ,lkfsl,V~l dh fjiksVZ fnukd a &15-03-2013 ( Annexure-8)] vihykFkhZ@vukonsd dk i= fnukd a &28-03-2013 ( Annexure-9)] ukfsVl dk tokc fnukd a &30-04-2013 ( Annexure-10) rFkk iksLVy jlhn ,oa ,DukWyt s esaV ( Annexure-11 & 12) dh QkVsks dkih izLrqr fd;k gSA 07- vihykFkhZ@vukonsd dh vkjs ls milt a kr gkuss okys fon~oku vf/koDrk Jh ih- d-s ikWy dk ;g rdZ gS fd ftyk Qkjse }kjk ikfjr vkykPs; vkn'sk =qfVi.wkZ gSA mRrjoknh@ifjoknh Lor% vius food s ls gSIih Qfseyh Q~ykVsj ikWfylh izkIr fd;k Fkk tks fd fHkUu ,oa uohu ikWfylh gS vkSj mlds }kjk iwoZ eas fy;s x;s ikWfylh dk uohuhdj.k ugha gS blfy, liaw.kZ lfaonkRed nkf;Ro ds fy, mRrjoknh@ifjoknh // 7 // nkf;Rok/khu gSA ftyk Qkjse us tks vius vkykPs; vkns'k dh dfaMdk&8 eas fVIi.kh fn;k gS og vuqfpr gS vkSj dsoy dYiuk ij vk/kkfjr gSA mRrjoknh@ifjoknh }kjk ,slk dkbsZ lk{; izLrqr ugha fd;k x;k gS ftlls izdV gks fd chek diauh ds ,tsVa ;k dkbsZ deZpkjh ds }kjk izHkkfor gkd s j mRrjoknh@ifjoknh us gSIih Qfseyh Q~yksVj ikWfylh fy;k gS rFkk ikWfylh ysus ds rRdky Ik'pkr~ mRrjoknh@ifjoknh vLoLFk gks x;k Fkk vkSj blfy, viotZu dzekd a &4-3 ds izko/kku ds varxZr mRrjoknh@ifjoknh {kfrifwrZ ikus dk vf/kdkjh ugha gS vkSj mlds nkos dks mfpr :Ik ls fujLr fd;k x;k gSA vr% ftyk Qkjse }kjk ikfjr vkykPs; vkn'sk fujLrh ;kXs; gSA vihykFkhZ@vukonsd dh vkjs ls vius i{k leFkZu eas Dr. Tarunjit Dutta Roy Vs. The Branch Manager The New India Assurance Company Ltd. 2013 NCJ 418 (NC), Export Credit Guarantee Corpn. Of India Ltd. Vs. M/s Garg Sons International 2013 (4) CPR 373 (SC), Deokar Exports Pvt. Ltd. Vs. New India Assurance Company Ltd. I (2009) CPJ 6 (SC), United India Insurance Co. Ltd. Vs. M/s Harchand Rai Chandan Lal 2005(1) CPR 64 (SC) dk voyacu fy;k g SA 08- mRrjoknh@ifjoknh dh vkjs ls milt a kr gkuss okys fon~oku vf/koDrk Jh jkt'sk ik.M;
s dk ;g rdZ gS fd ftyk Qksje }kjk ikfjr vkykPs; vkns'k i.wkZr% fof/k lEer gSA mRrjoknh@ifjoknh yxkrkj ikWfylh yrss jgk gS vkSj mlds ckn vpkud mlds }kjk gSIih Qfseyh Q~ykVsj ikWfylh fy;k tkuk bl ckr dk |ksrd gS fd chek diauh ds ,tasV ;k deZpkjh ds izHkkfor djus ij gh ikWfylh fy;k x;k gSA vihykFkhZ@vukonsd ba';kjsl as diauh }kjk dksbZ izikt s y QkeZ izLrqr ugha fd;k x;k gS tcfd og ,d egRoi.wkZ nLrkost gSA vihykFkhZ@vukosnd }kjk ikWfylh tkjh djrs le; mRrjoknh@ifjoknh dks 'krZ iznku ugha fd;k x;k gS vkSj ;fn 'krZ iznku fd;k tkrk rks mRrjoknh@ifjoknh // 8 // fuf'pr gh ikWfylh dks tkjh j[ks ;k ugha j[k]s bl lcaa/k eas fopkj djrk] blfy, vihykFkhZ@vukonsd viotZu [k.M dk ykHk ugha ys ldrk gSA ftyk Qkjse }kjk ikfjr vkykPs; vkn'sk iw.kZr% fof/k lEer gS] ml ij fdlh izdkj ds gLr{kis dh vko';drk ugha gSA 09- geus mHk;i{k ds fon~oku vf/koDrkvkas dk rdZ Jo.k fd;k rFkk ftyk Qkjse ds vfHky[sk dk Hkh ifj'khyu fd;kA 10- ifjokn&i= ds ifj'khyu ls Li"V gS fd mRrjoknh@ifjoknh iowZ eas ;qfuolZy gYsFk b'a;ksjasl ikWfylh dzekd a &152300@47@2009@157 tks fd fnukd a &24-11-2009 ls fnukd a &23-11-2010 rd dh vof/k ds fy, Fkk] izkIr fd;k Fkk vkSj fQj mDr ikWfylh dks uohuhdj.k djk;k Fkk vkSj mlds ckn mRrjoknh@ifjoknh }kjk gSIih QSfeyh Q~ykVsj ikWfylh izkIr fd;k x;k gSA vc ;g n[skuk gS fd D;k mDr ikWfylh mRrjoknh@ifjoknh }kjk vius Lo food s ls izkIr fd;k x;k g\S mRrjoknh@ifjoknh us iowZ eas ;qfuolZy gYsFk b'a;ksjsl a ikWfylh fy;k Fkk vkSj ftls uohuhdj.k Hkh djk;k Fkk vkSj mlds ckn ,dk,d o"kZ 2012 dh vof/k ds fy, gSIih Qfseyh Q~yksVj ikWfylh izkIr fd;k gSA mRrjoknh@ifjoknh us bl lcaa/k eas ;g vfHkopu fd;k gS fd vihykFkhZ@vukonsd }kjk mls lykg nh xbZ Fkh fd mRrjoknh@ifjoknh dks iowZ eas fy, x, ikWfylh ds LFkku ij gSIih Qfseyh Q~ykVsj ikWfylh yush pkfg,A gkykfad mRrjoknh@ifjoknh dh vkjs ls ,slk dkbsZ lk{; izLrqr ugha fd;k x;k gS ftlls ;g izdV gks fd mRrjoknh@ifjoknh dks vihykFkhZ@vukonsd ba';kjsl as daiuh }kjk gSIih Qfseyh Q~yksVj ikWfylh fy;s tkus grsq mdlk;k x;k gS ijUrq nks o"kkZsa rd ;qfuolZy gsYFk b'a;ksjsla ikWfylh fy;s tkus ds ckn mRrjoknh@ifjoknh }kjk gSIih Qfseyh Q~yksVj ikWfylh fy;k tkuk bl ckr dks bfaxr djus ds fy, // 9 // Ik;kZIr gS fd og dgha uk dgha ls izHkkfor gksdj mDr ikWfylh fy;k gSA ,l s h fLFkfr eas bl lHakkouk ls bd a kj ugha fd;k tk ldrk fd vihykFkhZ@vukonsd b'a;ksjsl a diauh ds fdlh vfHkdrkZ }kjk mRrjoknh@ifjoknh dks crk;s tkus ij mlus iowZ dh ikWfylh dk uohuhdj.k uk djkdj uohu ikWfylh gSIih Qfseyh Q~yksVj ikWfylh fy;k gSA gkykfad ftyk Qksje us vkns'k dh dfaMdk&8 eas tks vU; Vhi fn;k gS og mfpr ugha gS vkSj mldh vko';drk ugha Fkh ijUrq ftyk Qksje us dYiuk ds vk/kkj ij mDr fVIi.kh fn;k gS tks mfpr ugha dgk tk ldrk ijUrq ftyk Qkjse us tks ;g fu"d"kZ fudkyk gS fd mRrjoknh@ifjoknh }kjk izHkkfor gkd s j gh gSIih Qfseyh Q~yksVj ikWfylh fy;k x;k gS og Lohdkj fd;s tkus ;ksX; gSA 11- tgka rd ikWfylh dh 'krkZsa dk lca/ak gS mudk vFkkZUo;u mlh vuq:i fd;k tkuk gkrsk gS tSlk og mYyfs[kr gS rFkk dkbsZ Hkh U;k;ky; ;k Qkjse ;k fVªC;uwy ikWfylh dh 'krkZsa eas viuh 'krkZsa dks lekfo"V ugha dj ldrk gSA 12- vc ;g n[skuk gS fd D;k bl izdj.k eas mRrjoknh@ifjoknh us tks gSIih Qfseyh Q~yksVj ikWfylh fy;k gS mlds viotZu DykWt ds v/khu mRrjoknh@ifjoknh ds nkos dks vLohdkj fd;k tkuk fof/k lEer g\S 13- mRrjoknh@ifjoknh dh vkjs ls ;g Li"V :Ik ls crk;k x;k gS fd mRrjoknh@ifjoknh dks chek ikWfylh tkjh djrs le; chek 'krkZsa dks iznk; ugha fd;k x;k FkkA vihykFkhZ@vukonsd b'a;ksjsl a diauh us ikWfylh ds lkFk 'krZ dks Hkh i'sk fd;k gS vkSj ;g crkus dk iz;kl fd;k gS fd mRrjoknh@ifjoknh dks Hkh 'krZ iznku fd;k x;k Fkk] ijUrq // 10 // vihykFkhZ@vukonsd ba';kjsl as daiuh dk mDr rdZ Lohdkj ;kXs; ugha gSA ;fn okLro esa ikWfylh dh 'krZ mRrjoknh@ifjoknh dks fn;k x;k gksrk rks mRrjoknh@ifjoknh] iwoZ ds ikWfylh dks NksMd + j gSIih Qfseyh Q~ykVsj ikWfylh fy;s tkus ds lac/ak esa fopkj djrkA vihykFkhZ@vukosnd b'a;ksjsl a daiuh dh vksj ls mRrjoknh@ifjoknh }kjk fn, x, iziksty QkeZ dks Hkh izLrqr ugha fd;k x;k gS tcfd izikt s y QkeZ vihykFkhZ@vukonsd ba';kjssl a diauh ds vkf/kiR; esa jgrk gS vkSj og ,d egRoi.wkZ nLrkot s gS vkSj mlds vHkko eas ;g ugha dgk tk ldrk fd mRrjoknh@ifjoknh us vius Lo food s ls gh gSIih Qfseyh Q~ykVsj ikWfylh dz; fd;k gS vkSj mRrjoknh@ifjoknh }kjk ikWfylh cnyuk bl ckr dk |ksrd gS fd og dgha uk dgha ls izHkkfor gkd s j iqjkuk ikWfylh ds LFkku ij gSIih Qfseyh Q~yksVj ikWfylh izkIr fd;k gS vkSj bu lc ifjfLFkfr;kas ds vk/kkj ij ;g ugha dg k tk ldrk fd mRrjoknh@ifjoknh us vius Lo food s ls mDr ikWfylh dks dz; fd;k gS rFkk ikWfylh 'krkZsa dks Hkh iznku ugha fd;k x;k gSA bu lc ifjfLFkfr;ksa dks ns[krs gq, vihykFkhZ@vukosnd] viotZu [k.M dz- 4-3 dk ykHk ikus dk vf/kdkjh ugha gS tks fuEukuqlkj gS%& 4.3 The expenses on treatment of following ailment/diseases/surgeries for the specified periods are not payable if contracted and/or manifested during the currency of the policy.
If these diseases are pre-existing at time of proposal the exclusion no 4.1 for pre-existing condition SHALL be applicable in such cases.
Xvii Hypertension 2 Years
Xviii Diabetes 2 Years
If the continuity of the renewal is not maintained with the Company then subsequent cover SHALL be treated as fresh // 11 // policy and clauses 4.1, 4.2, 4.3 SHALL apply unless agreed by the Company and suitable endorsement passed on the policy. Similarly if the sum insured is enhanced subsequent to the inception of the policy, the exclusions 4.1, 4.2 and 4.3 will apply afresh for the enhanced portion of the sum insured for the purpose of this section.
14- mijkDsr foospuk ds ifjiz{s; eas ftyk Qksje us tks fpfdRlk esa dkfjr O;; 1]00]000@&¼,d yk[k :Ik;½s fnyk;s tkus dk vkns'k ikfjr fd;k gS og i.wkZr% mfpr gS] mlesa fdlh izdkj ds gLr{ksi dh vko';drk ugha gSA 15- tgka rd C;kt] ekufld ihMk+ ,oa okn O;; dk lac/ak gS] bl lcaa/k esa ftyk Qkjse }kjk ikfjr vkykPs; vkn'sk fLFkj j[ks tkus ;kXs; ugha gSA ftyk Qkjse us 1]00]000@&¼,d yk[k :Ik;½s ij ifjokn fnukd a &10-05-2013 ls vnk;xh fnukd a rd 18 izfr'kr lk/kkj.k okf"kZd C;kt fnyk;k gS tks fd vR;f/kd gSA mRrjoknh@ifjoknh dks mDr 1]00]000@&¼,d yk[k :Ik;½s ij ifjokn izLrqfr fnukd a &10-05-2013 ls ls vnk;xh rd 09 izfr'kr okf"kZd dh nj ls C;kt fnyk;k tkuk mfpr gkx s kA 16- tgka rd ekufld ihMk+ dk lca/ak gS] mRrjoknh@ifjoknh dks 25]000@&¼iPphl gtkj :Ik;½s fnyk;k x;k gS og Hkh vR;f/kd gS] mlds LFkku ij mRrjoknh@ifjoknh dks ek= 5]000@&¼ikp a gtkj :Ik;½s fnyk;k tkuk mfpr gkx s kA ftyk Qkjse }kjk okn O;; dk 10]000@&¼nl gtkj :Ik;½s fnyk;k x;k gS] izdj.k dh ifjfLFkfr dks ns[krs gq, okn O;; 2]000@&¼nks gtkj :Ik;½s fnyk;k tkuk mfpr gkx s kA // 12 // 17- vr% vihykFkhZ@vukonsd ba';kjsasl daiuh dh vihy vkfa'kd :Ik ls Lohdkj fd;k tkrk gSA ftyk Qksje }kjk tks mRrjoknh@ifjoknh dks 1]00]000@&¼,d yk[k :Ik;½s fnyk;s tkus dk vkn'sk ikfjr fd;k gS mls ;Fkkor~ j[kk tkrk gS ijUrq C;kt] ekufld ihMk+ ,oa okn O;; ds lcaa/k eas ftyk Qksje }kjk ikfjr vkn'sk dks l'akkfs/kr djrs gq, vknfs'kr fd;k tkrk gS fd vihykFkhZ@vukonsd b'a;kjsasl diauh] mRrjoknh@ifjoknh dks 1]00]000@&¼,d yk[k :Ik;½s ij ifjokn izLrqfr fnukd a &10-05-2013 ls vnk;xh fnukd a rd 09 izfr'kr lk/kkj.k okf"kZd dh nj ls C;kt vnk djx s k rFkk ekufld ihMk+ ds fy, 5]000@&¼ikp a gtkj :i;½s ,oa okn O;; dk 2]000@&¼nks gtkj :Ik;½s vnk djx s kA bl vihy dk O;;
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