Chandigarh

StateCommission

A/181/2023

ICICI LOMBARD GENERAL INSURANCE COMPANY LIMITED - Complainant(s)

Versus

CHARAN PAL SINGH S/O SH INDERJIT SINGH - Opp.Party(s)

ER. SANDEEP SURI

02 Aug 2023

ORDER

STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

U.T., CHANDIGARH

 

 

Appeal No.	:	181 of 2023
Date of Institution	:	26.07.2023
Date of Decision	:	02.08.2023

 

 

 

 

 

 

1]      ICICI LOMBARD GENERAL INSURANCE COMPANY LIMITED, ICICI Lombard House 414 Veer Savarkar Marg, Near Sidhi Vinayak Temple, Prabhadevi, Mumbai 400025 through its Branch Manager.

2]      ICICI LOMBARD GENERAL INSURANCE COMPANY LIMITED, Plot No.149, Industrial Area, Chandigarh through its Manager.

….Appellants/Opposite Parties.

Versus

CHARAN PAL SINGH S/o Sh. Inderjit Singh, R/o House No.2137, Phase X, Sector 64, SAS Nagar, Mohali, Punjab.

...Respondent/Complainant.

 

 BEFORE:  JUSTICE RAJ SHEKHAR ATTRI, PRESIDENT

              MR. RAJESH K. ARYA, MEMBER

 

ARGUED BY :-  

 

Er. Sandeep Suri, Advocate for the appellants.

 

PER  RAJESH  K. ARYA, MEMBER

                This appeal has been filed by the opposite parties (ICICI LOMBARD GENERAL INSURANCE COMPANY LIMITED) (appellants herein), against order dated 25.07.2022, vide which,  the District Consumer Disputes Redressal Commission-II, U.T., Chandigarh (in short ‘District Commission’), while allowing consumer complaint No.978 of 2019 filed by the complainant (respondent herein), directing the appellants to reimburse the medical expenses so incurred by the respondent as per the terms and conditions of the insurance policy besides payment of Rs.15,000/-  & Rs.10,000/- as compensation and litigation charges respectively. It also directed to treat the policy, in question, as revived from the date of cancellation and liberty was given to the respondent to renew it accordingly subject to payment of the due premium.

2]                The case of the respondent before the District Commission was that he had taken Health Insurance Policies since 2004 and never made any claim with the Company. It was port policy and was renewed in February, 2019 by paying Rs.50,812/- as premium for sum assured of Rs.5 Lakhs.  The respondent got admitted in Max Health Care Hospital, Mohali with pain in left hip on 09.04.2019 and surgery was conducted on 10.04.2019. He told the doctor that he was suffering from hypertension for the last two months but by mistake in the history of discharge summary, the doctor had written two years in place of two months and the said mistake was rectified by one of his team mate named Dr.Mayank vide letter dated 15.04.2019 and he also mentioned that the hypertension is not related with hip problem.  However, the appellants rejected the claim vide letter dated 30.05.2019 (Annexure C-6) on the ground that the respondent was suffering from hypertension. 

3]                On the other hand, the appellants pleaded in their written statement that on receipt of the documents, the claim of the respondent was investigated and during investigation, it was found that as per the report of the hospital dated 20.01.2019, the respondent was suffering from hypertension and had been taking the medicines for the same and thus, his claim was rightly repudiated on the ground that he did not disclose the fact that he was suffering from hypertension at the time of taking the health policy.

4]                Learned Counsel for the appellants argued that the respondent had a pre-existing disease at the time of taking the Insurance Policy, which he did not disclose to the Insurance Company. He further argued that it is the duty of the insured person to provide all necessary information but the respondent failed to discharge this duty and breached the terms of the policy.

5]                After hearing the learned Counsel for the appellant and going through the impugned order and the record carefully, we are of the concerted view that there is no force in the argument raised by the learned Counsel for the appellants and the present appeal is liable to be dismissed, at the preliminary stage, for the reasons to be recorded hereinafter. The only question to be determined was whether the hypertension caused hip problem or had any nexus with each other. This issue has rightly been answered by the District Commission by holding that neither the hypertension caused hip problem nor there was any nexus between the two. In its order, the District Commission also referred to the law settled by Hon’ble Supreme Court of India and Hon’ble National Consumer Disputes Redressal Commission, New Delhi. In  New India Assurance Co. Ltd. Vs. Arun Krishan Puri, III(2009) CPJ 6 (NC), the Hon’ble National Commission held that onus to prove the pre-existing disease of the insured at the time of taking the policy lay on the insurer. Further in Revision Petition No.3619 of 2013 – Satish Cahnder Madan Vs. M/s. Bajaj Allianz General Insurance Co. Ltd., decided on 11.1.2016, the Hon’ble National Commission held that “Hypertension is a common ailment and it can be controlled by medication – Claim was wrongly repudiated.” Not only above, the Hon’ble Supreme Court of India in Biman Krishna Bose Vs. United India Insurance Company, civil Appeal No.3438 of 1995, has held that if a person is suffering from hypertension, the insurance claim of the legal heirs of such a person cannot be repudiated on the ground that the life assured had suppressed this information from the Insurance Company. Moreover hypertension is not a material disease which is fatal in itself. Thus, it is well established under law that Hypertension is not a material disease and is manageable by medication/meditation, change of life style etc. and as such, cannot be a ground for rejection of genuine claims. Furthermore, the disease hypertension, which means tension or tonus that is greater than normal, a condition in which the patient has a higher blood pressure than that judged to be normal, cannot be treated as a disease in the same manner as the diseases such as kidney, heart and brain, which directly affect the life span of a person and apart from this, hypertension is not a permanent disease and it sometimes increases and sometimes it reduces and thus, non mentioning of such type of disease in the declaration form would not amount to mis-statement in real sense. From this point of view also, repudiation of claim of the respondent by the appellants was not justified. In our considered view, the appellants have failed to make out any ground to interfere with the well reasoned order of the District Commission.

6]                It may also be stated here that there is a delay of 320 days in filing the appeal and the only ground mentioned in the application (MA/576/2023) seeking condonation of delay is that the documents pertaining to the original consumer complaint, received from the earlier Counsel, were misplaced by an office clerk working with the counsel and the same were discovered by chance in another file, and as such, delay in filing the appeal occurred. Though the reasons stated in the application are supported by an affidavit of Sh. Vivek Kumar, working at the office of Counsel, yet we do not find it to be a sufficient reason to condone such a huge delay of 320 days. Therefore, the application for condonation of delay stands dismissed.

7]                For the reasons recorded above, the appeal is dismissed, at the preliminary stage, with no orders as to costs. MA/577/2023 for stay also stands dismissed having been rendered infructuous.

8]                Certified copies of this order be sent to the parties free of charge.

9]                File be consigned to Record Room after completion.

Pronounced.

02.08.2023.

(RAJ SHEKHAR ATTRI)

PRESIDENT

 

 

 

(RAJESH K. ARYA)

MEMBER

 

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