Chandigarh

StateCommission

A/226/2019

Supriya - Complainant(s)

Versus

Max Bupa Health Insurance Company Ltd. - Opp.Party(s)

In Person

11 Oct 2019

ORDER

        STATE CONSUMER DISPUTES REDRESSAL COMMISSION,

U.T., CHANDIGARH

 

 

Appeal No.	:	226 of 2019
Date of Institution	:	04.10.2019
Date of Decision	:	11.10.2019

 

1.  Supriya Arora daughter of Shri Manohar Lal Arora, resident of House No.65, Seori Bitna, Pinjore, Kalka, District Panchkula presently residing at 15 Valmiki Street, Flat No.B2 Ceebros Castel T Nagar, Chenna.

2.  Manohar Lal Arora son of Sh. Pratap Chand Arora resident of House No.65, Seori Bitna, Pinjore, Kalka, District Panchkula

 …….Appellants/Complainants.

Versus

 

1.  Max Bupa Health Insurance Co. Ltd., B-1/1-2, Mohan Cooperative Industrial Estate, Mathura Road, New Delhi – 110044.

 

2.  Max Bupa Health Insurance Co. Ltd., SCO No.55-56-57, Sector 8-C, Madhya Marg, Chandigarh.

 

...Respondents/Complainants.

 

Appeal under Section 15 of the Consumer Protection Act, 1986

 

BEFORE: MRS. PADMA PANDEY, PRESIDING MEMBER.

                MR. RAJESH K. ARYA, MEMBER.

       

Argued by:

 

Appellants in person.

 

PER  RAJESH  K.  ARYA, MEMBER

                   In this appeal laying challenge to order dated 24.07.2019 passed by District Consumer Disputes Redressal Forum-II, U.T., Chandigarh (in short ‘the Forum’ only) in Consumer Complaint bearing No.688 of 2018, the complainants are seeking enhancement of relief granted by the Forum while allowing their complaint.

2.             In the grounds of appeal, it has been stated that the claim of the appellants/complainants despite the fact that the policy was renewed for the period from 2017 to 2018 on the basis of medical examination already conducted in the year 2016. It has further been stated that the respondents took the premium amount on the pretext of renewal of policy for the period 2018-2019 but till date neither they had issued the policy nor returned the premium amount. It has further been stated that the appellants had already sent a letter alongwith draft of Rs.41,000/-, in advance, towards premium for the policy for the year 2018-2019 and as such, the policy needs to be renewed in favour of the complainants and the complainants need to be compensated for full year. It has also been stated that the complainants have suffered lot of mental agony and pain on account of illegal action of the opposite parties, for which they need to be compensated on a higher side and amount of Rs.15,000/- awarded on that count by the Forum is very meager. It has also been stated that the litigation expenses of Rs.7,000/- awarded by the Forum also does not meet the actual expenses incurred by the appellants in the present litigation, which also needs to be enhanced. During the course of hearing, it has been added that the interest awarded at the rate of 8% p.a. on the claim amounts from the date of filing the complaint is also meager and rather it should have awarded from the date, when cause of action actually arises in favour of the complainants.

3.             After hearing submissions made by the appellants/complainants and also going through the material available on record, we are of the considered opinion that the Forum has adequately compensated the appellants and no case is made out for any kind of enhancement in the relief awarded by the said Forum and as such, the appeal is liable to be dismissed at the admission stage.                  

4.             It is not in dispute that the complainants took Family First Silver 5 Lacs + 15 Lacs Mediclaim Insurance policy in November 2016 wherein, it was clearly mentioned that complainant No.2 was suffering from Diabetes since 2012.  The said policy was got renewed by the complainants for further period from 8.11.2017 to 7.11.2018, during which period, admittedly, appellant No.2 took treatment twice i.e. from 1.4.2018 to 15.4.2018 and 18.4.2018 to 23.4.2018, at Fortis Hospital, Mohali.  However, the claims lodged by the complainants qua medical expenses incurred was rejected by the opposite parties.

5.             The Forum has given a categoric finding that the opposite parties  have not only wrongly & illegally rejected both the claims of complainant No.2 but also illegally cancelled the policy, in question, thus, depriving them from the benefit of the said policy. The Forum has also rightly held that complainant No.1 applied for the renewal of the policy by submitting cheque amounting to Rs.41,000/- towards the premium but the same was declined by the respondents, which further amounted to deficiency in service on their part. Not only this, the Forum has also observed that Insurance Certificate (Annexure C-1) and proposal form make it clear that complainant No.2 clearly mentioned about his pre-existing diseases i.e. Diabetes Mellitus and Hypertension suffering since 2012 at the time of availing the policy. It also rightly held that no authentic document was placed on record by the opposite parties to establish that complainant No.2 was suffering from Hypertension and Diabetic Mellitus since 17 years and as such, there was no question of any concealment or misrepresentation on the part of the complainants and rejection of claim as well as cancellation of policy on that ground was highly objectionable and not justified.

6.             The Forum, while directing the opposite parties to restore the policy, in question, also directed to reimburse the claim amounts alongwith interest @8% p.a. from the date of filing the complaint. As per argument raised by the appellants/complainants, the rate of interest awarded by the Forum is on the lower side and it should have been awarded from the date, when cause of action arose in favour of the complainants. We reject this argument. In our opinion, 8% interest, in these days, cannot be said to be on the lower side. These days, the banks in saving bank accounts are giving interest ranging between 3.50% to 4% and on Fixed Deposit Receipts, a maximum of 6% to 6.50% depending upon the term and amount of such deposit. Immediately after repudiation, the complainants filed the complaint on 04.12.2018 and the Forum rightly awarded interest from the said date. Thus, in our considered opinion, interest @8% p.a. awarded by the Forum, which is more than the prevailing market rate of interest, on the claim amounts from the date of filing the complaint i.e. 04.12.2018 till date of realization, is just and adequate.

7.             The next argument raised qua lesser award of compensation for causing harassment & mental agony and litigation expenses by the Forum is also rejected being unsustainable in the eyes of law. In our considered opinion, taking into consideration the sufferance and harassment suffered by the complainants, they (complainants) have adequately and sufficiently been compensated by the Forum by way of interest awarded @8% p.a. besides award of Rs.15,000/- as compensation for harassment & mental agony and Rs.7,000/- towards litigation expenses.

8.             Accordingly, the appellants/complainants have miserably failed to make out any case of enhancement.

9.                 For the reasons recorded above, the appeal is dismissed  at the preliminary stage with no order as to costs. Consequently, the application for condonation of delay, bearing M.A.No.692 of 2019, in filing the appeal also stands dismissed having become infructuous. The impugned order dated 24.07.2019 passed by District Forum-II, U.T., Chandigarh in Consumer Complaint bearing No.688 of 2018 is been upheld.

10.           Certified copies of this order, be sent to the parties, free of charge.

11.           The file be consigned to Record Room, after completion.

Pronounced.

11.10.2019.

[PADMA PANDEY]

PRESIDING MEMBER

 

 

(RAJESH  K. ARYA)

MEMBER

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