BEFORE THE TELANGANA STATE CONSUMER DISPUTES REDRESSAL COMMISSION : HYDERABAD.

FA.NO.486 OF 2020 AGAINST ORDERS IN CC.NO.213 OF 2018, DISTRICT CONSUMER COMMISSION-I, HYDERABAD Between:

1. M/s.Religare Health Insurance Company Ltd., Rep. by its Managing Director, Regd. Office: 5th Floor, 19, Chawla House, Nehru Palace, New Delhi – 110 019.

2. M/s.Religare Health Insurance Company Ltd., Rep. by its Regional Manager, Begumpet, Hyderabad – 100 016.

Telangana State.

.…Appellants/Opp.Parties And Mr.Y.Venkateswara Rao S/o.Sri Late Sri Seetha Ramaiah, Aged: 68 years, Occ: Retired Employee, R/o.Plot No.83, Shivbagh Colony, Hyderabad, Telangana State – 500 016.

…..Respondent/Complainant Counsel for the Appellants/Opp.Parties : M/s. N.Srinath Rao Counsel for the Respondent/Complainant: Sri B.Sreehari QUORAM:

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

HON’BLE SRI V.V.SESHUBABU, MEMBER-JUDICIAL THURSDAY, THE TWENTIETH DAY OF FEBRUARY TWO THOUSAND TWENTY FIVE *******

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

1. This is an appeal filed by the Appellants/Opposite Parties U/s.41 of Consumer Protection Act, 2019, praying this Commission to set aside the order dated 19.03.2020 in CC.No.213 of 2018 on the file of District Consumer Disputes Redressal Forum-I, Hyderabad and pass such other order or orders as are deemed fit and proper in the circumstances of the case.

2. For the sake of convenience, the parties are described as arrayed in the complaint. The Appellants are the Opposite Parties and the Respondent is the Complainant in CC.No.213/2018.

3. Briefly stated, the facts are that – the Complainant’s wife had obtained a mediclaim policy under the name: Care, Policy No.10052846 with client ID: 50665650 effective from 26.05.2014 for one year and it was regularly renewed each year. On 23.09.2017, the policy holder’s husband who is also covered under the subject policy and the Complainant herein underwent angioplasty and incurred an expense of Rs.2,26,922/- but his claim was rejected on the following grounds:

 Main claim rejected  Benefit not covered in policy Hence, the complaint.

4. The Opposite Parties No.1 & 2 filed their written version and mainly contended that as per the policy certificate, the Complainant is not covered under the policy. The Complainant’s wife had purchased two policies vide numbers 10109241 and 10052846 for sum insured of Rs.4,00,000/- and Rs.3,00,000/- respectively and it was renewed subject to terms and conditions. Based on the information provided by the hospital, it is observed that the Complainant was suffering from Diabetes Mellitus since 20 years and had maliciously disclosed in the proposal form that he was suffering from Diabetes Mellitus from past 2 years only. For non-disclosure of the material facts, the same was communicated to the Complainant vide their letter dated 20.12.2017 and a notice for cancellation vide letter dated 17.02.2018 and 17.03.2018 were dispatched to the Complainant. It is therefore prayed to dismiss the complaint with costs in the interest of justice.

5. Before the District Commission, the Complainant filed evidence affidavit and got marked Ex.A1 to A13 on his behalf. The Opposite Parties filed evidence affidavit. Ex.B1 to B11 are marked on their behalf.

6. The District Commission after hearing and considering the material on record, allowed the complaint in part by directing the Opposite Parties (i) to pay the sum of Rs.2,33,091/- to the Complainant, along with interest at the rate of 12% per annum from the date of submission of the claim till realization; (ii) to pay Rs.50,000/- towards compensation and to pay Rs.5,000/- as litigation expenses. This order be complied with by the Opposite Parties, within 45 days from the date of receipt of the order, failing which the amounts at Sr.No.(i) & (ii) above shall carry interest @ 12%

per annum from the date of this order till actual payment.

7. Aggrieved by the said order of the District Commission, the Appellants/Opposite Parties