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Showing contexts for: unsigned document in Mr. Premjeet Sharma vs Apollo Munich Health Insurance Co. on 30 August, 2018Matching Fragments
1. Being aggrieved by the order in the Consumer Complaint No. 402 of 2013, passed by the Learned DISTRICT CONSUMER FORUM, MUMBAI SUBURBAN DISTRICT, BANDRA partly allowing the complaint, and awarding the refund of the premium with deductions of Rs.5000/- towards administrative expenditure,the present appeal has been preferred by the original complainant under Sec.15 of the Consumer Protection Act 1986.
2. Facts necessary for deciding this appeal are as under; The complainant had purchased Easy health insurance policy for his parents from the opposite party number 2 bearing policy number 1000 1433 19- 02 having face value of Rs. 4,80,000/- that started from 1st December 2010. Complainant's mother Ms. Indu Sharma underwent heart surgery (aortic and mitral valve replacement) in 3rd year of the policy in Kokilaben Dhirubhai Ambani hospital, Mumbai on 3rd August 2013. The diagnosis was rheumatic heart disease- Severe AS, severe to moderate MS, moderate PAH. The complainant had paid a premium amount of rupees 15,274.09 per annum. The opposite party- respondents the internet bill submitted to them and give approval to Rs. 4, 80,000/- totally. The documents submitted by the hospital to the TPA, contained an unsigned handwritten discharge summary which mentioned that the appellant's mother was suffering from rheumatic heart disease since last 15 years. Hospital replied to the query of insurance company and sent the certificates from the heart surgeons that the actual 3 (A/16/2987) suffering of the patient was six to eight months. Relying upon the unsigned handwritten discharge summary, the insurance company repudiated the claim. Additionally terminated the insurance policy and eventually cancelled the same, after finding in the proposal form of the policy "non-disclosureof the pre-existing rheumatic heart disease for 15 years". The appellant complainant approached learned District Consumer Disputes Redressal Forum, Sub Urban District, Bandra, Mumbai. Aggrieved by the judgement and the Order of the learned forum, the complainant has preferred this appeal and approached this state Commission.