State Consumer Disputes Redressal Commission
New India Assurance Co. Ltd. vs Dharamveer Kapoor on 2 January, 2012
IN THE STATE COMMISSION:DELHI IN THE STATE COMMISSION: DELHI (Constituted under Section 9 of The Consumer Protection Act, 1986) Date of Decision: 02.01.2012 First Appeal No.2011/419 (Arising out of Order dated 26.05.2011 passed by the District Consumer Forum( New Delhi) Kasturba Gandhi Marg, New Delhi in Complaint Case No.199/2005) New Indian Assurance Co. Ltd.. Appellant/Opposite Party 12/1, Asaf Ali Road, through Mr. Navdeep Singh New Delhi. Advocate. Versus 1. Sh. Dharamveer Kapoor, .Respondents/Complainant. C/o Sh. Rajan Kapoor M/s. Kay Star Knit Wears, 58/4365, Regharpura, Karol Bagh, New Delhi -5 2. M/s. T.T.K. Healthcare Services Pvt. Ltd., Flat No.103-104, 1st Floor, Rohit House, 3, Tolstoy Marg, Connaught Place, New Delhi. CORAM Justice Barkat Ali Zaidi ... President Ms. Salma Noor Member
1. Whether reporters of local newspapers be allowed to see the judgment?
2. To be referred to the Reporter or not?
Justice Barkat Ali Zaidi, President -ORAL
1. The short facts of the case are that the respondent/complainant obtained a mediclaim policy from the OP, which was continuing for the last six years. On 18.06.2007, the complainant was hospitalized and was operated for hernia, which for he paid to Maharaja Agrasen Hospital a bill of Rs.34,772/-. The complainant claimed reimbursement of the aforesaid amount from the OP, which the OP refused to pay on the ground that it was a pre-existing disease. The complainant therefore filed a complaint before District Forum with the prayer that the OP be directed to pay in total Rs.75,000/- towards the said amount, interest, legal expenses and mental agony and other expenses.
2. The OP filed its written statement and opposed the claim denying any deficiency in service on its part pleading that it was a pre-existing disease.
3. On consideration of evidence of both the parties and hearing them, the District Forum repelled the contention of the OP saying that hernia cannot be called a pre-existing disease because hernia is a medical condition, needing repair of the muscle, and that the complainant was free of it for last six years, and decreed the claim of the complainant directing the OP to pay the complainant Rs.34,772/- alongwith interest @9% and pay Rs.15,000/- as compensation and litigations costs.
4. That is what brings the OP insurance company in appeal before this Commission.
5. We have heard Sh. Navdeep Singh, Counsel for the OP Insurance Company in this appeal at the stage of admission.
6. There is no merit in this appeal. Medi-claim insurance policy was in force for last six years therefore the contention of the OP that it was a pre-existing disease is condemnable. It is undisputable that the complainant was suddenly admitted to the hospital and was operated for inguinal hernia problem, which for he paid Rs.34,772/-. The District Forum was therefore wholly justified in decreeing the claim of the complainant as mentioned above.
7. Appeal dismissed in limine.
8. Bank Guarantee/FDR, if any furnished by the appellant, be returned forthwith.
9. A copy of this order as per the statutory requirements be forwarded to the parties free of charge and also to the concerned District Forum and thereafter the file be consigned to Record room.
Announced on 2nd day of January 2012.
(Justice Barkat Ali Zaidi) President (Salma Noor) Member Tri