Haryana

Karnal

CC/11/2023

Ram Nath - Complainant(s)

Versus

Star Health And Allied Insurance Company Limited - Opp.Party(s)

Narender Sharma

10 Jan 2023

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, KARNAL.

                                                                     Complaint No.11 of 2023

                                                                     Date of instt.09.01.2023

                                                                     Date of Decision:10.01.2023

 

Ram Nath son of Sh. Surta Ram resident of village Unispur, tehsil Nilokheri, district Karnal.                         

…….Complainant.

                                                Versus

Star Health and Allied Insurance Company Limited, SCO-104 first floor, Mugal Canal, sector-13, Extension, Sector-13, Karnal through its Branch Manager.

                                                                                      …..Opposite Party.

Complaint under Section 35 of Consumer Protection Act, 2019.

Before       Sh. Jaswant Singh………President.  

                   Sh. Vineet Kaushik……… Member.

                   Smt. Dr. Rekha Chaudhary……..Member.

 

Present: Sh. Narender Sharma, counsel for the complainant.

                 

                Complaint presented today. It be checked and registered.

                The complainant has filed the present complaint under Section 35 of the Consumer Protection Act, 2019 against the opposite parties (hereinafter referred to as (OPs) on the averments that complainant purchased a Health Policy namely “Family Health Optima Insurance Plan” from the opposite party vide policy no.P/211114/01/2022/012000, valid from 02.01.2022 to midnight of 01.01.2023 and the said insurance plan covered the complainant himself, his wife Suman Devi, his sons Ajay and Kamal. The complainant paid a sum of Rs.11,880/- to the opposite party and the policy was issued in the name of complainant.

                  That during the subsistence of the above said policy. The complainant started suffering from left ear problem and he approached Amrithdara Hospital Pvt., Ltd., and after investigation, the complainant was found to be suffering from Ear Moderate Conductive hearing loss with 2KHZ Notch At Bc., and he was advised to get his ear operated for the said disease and accordingly, the complainant was operated upon for the said disease on 20.05.2022. The complainant remained admitted in the hospital from 19.05.2022 and a sum of Rs.60,000/- towards treatment charges and purchase of medicines. The claim of the complainant has been repudiated by the OP without any cogent reasons. Hence, the complaint.

      Arguments on the point of admissibility heard.

     The claim of the complainant has been repudiated by the OPs, on the ground that the complainant has been suffering from this disease since 23.03.2016, which is prior to inception of the first policy and it is a pre-existing disease.

     Learned counsel for the complainant has submitted that before inception of the policy in question the complainant was suffering from said problem in the right ear and now he has got operation of the left ear, and he has not taken any treatment previously of the right ear. Admittedly, complainant was suffering from ear problem before purchasing of the policy. This fact has not been disclosed while filling the proposal form. Complainant has concealed true and material facts at the time of filling of the proposal form. Complainant has taken a treatment of the ear and it hardly matters whether he has taken the treatment of the right and left ear. Meaning thereby complainant was suffering from ear disease before inception of the policy. Hence, the claim of the complainant has been rightly repudiated by the OP. Thus, the present complaint is devoid of merits and same deserves to be dismissed and same is hereby dismissed. Parties concerned be communicated of the order accordingly and file be consigned to the record room.

Announced
Dated:10.01.2023                

                      President,

District Consumer Disputes

Redressal Commission, Karnal.

 

(Vineet Kaushik)   (Dr. Rekha Chaudhary) 

  Member                Member