BEFORE THE TELANGANA STATE CONSUMER DISPUTES REDRESSAL COMMISSION : HYDERABAD.

FA.NO.760 OF 2024 AGAINST ORDERS IN CC.NO.173 OF 2023, DISTRICT CONSUMER COMMISSION-II, HYDERABAD Between:

The Divisional Manager Office III, United India Insurance Company, United India Towers, 2^nd Floor, Basheerbagh, Hyderabad.

.…Appellant/Opp.Party And Smt.Seetha Nagarajan, W/o.Late K.Nagaraju, Aged 85 years, Occ: Widow, R/o.1-10-144, # 101, Kamala Manohar Redsidency, Street No.8, Ashok Nagar, Hyderabad.

…..Respondent/Complainant Counsel for the Appellant/Opp.Party: M/s.M.Shanker Counsel for the Respondent/Complainant: M/s.Mirza Abbas Ali Khan QUORAM:

HON’BLE SMT.MEENA RAMANATHAN…IN-CHARGE PRESIDENT &

HON’BLE SRI V.V.SESHUBABU, MEMBER-JUDICIAL MONDAY, THE FIF TH DAY OF MAY TWO THOUSAND TWENTY FIVE *******

Order : (Per Smt.Meena Ramanathan, Hon’ble In-charge President)

1. This is an appeal filed by the Appellant/Opposite Party U/s.41 of Consumer Protection Act, 2019, praying this Commission to allow the appeal/set aside the order dated 19.04.2024 in CC.No.173/2023 of the District Commission-II, Hyderabad.

2. For the sake of convenience, the parties are described as arrayed in the complaint. The Appellant is the Opposite Party and the Respondent is the Complainant in CC.No.173/2023.

3. Briefly stated, the facts are that – the Complainant obtained an Individual Health Policy from the Opposite Party bearing Policy No.0514082819P110592136 by paying a total premium of Rs.32,154/-. The said policy period was from 21.11.2019 to 20.11.2020. The Complainant originally availed Health Insurance Policy from Opposite Party in the year 2004. The policy is being renewed from time to time regularly and paid the annual premiums in time till 2020. It is submitted that since the year 2004 to till date, she had made no claims and was never hospitalized due to any illness.

4. It is submitted that in the year 2020, the Complainant could not pay the premium for renewal due to misplacement of her mediclaim file. This was not intentional but was due to oversight. The Complainant realized that she had not paid annual premiums for renewal of the policy for the period 2020-21, 2021-22 and 2023-24. Immediately she approached Opposite Party and made a representation on 27.04.2023 at Hyderabad Office, but there was no reply. The Complainant, who is a senior citizen, through her daughter/nominee approached the Opposite Party vide letter dated 28.04.2023 and requested to revive the policy by considering her track record and her age.

5. The Complainant submitted that if an insured person fails to pay the premium due to various circumstances and as a result the Insurance Policy gets terminated, then the Insurance coverage can be renewed. This process of putting the insurance policy back after lapse is known as reinstatement. There was no reply for her representations. Hence, the complaint with a prayer as mentioned below:

“To direct the Opposite Party to restore/reinstate/revival the Complainant’s individual health policy; to direct the Opposite Party to compensate all the amounts paid by the Complainant towards the Insurance Policy and award costs.”

6. The Opposite Party filed their written version stating that the complaint is barred by limitation. The Complainant had not filed any petition seeking condonation of delay. As such the complaint is not maintainable and liable to be dismissed in limini. The allegations of the Complainant does not come within the meaning of Section 2(6) of C.P.Act as the Complainant had not alleged specifically any deficiency of service which is the main ingredient to institute a complaint before this Commission.

7. It is submitted that the policy can be renewed within the grace period only as mentioned in the policy. The policy lapsed on 20.11.2020 and according to the condition of the policy, the grace period will expire on 30 days i.e., 20.12.2020. The Complainant approached the Opposite Party on 27.04.2023 i.e., after lapse of two years and four months after the