| First Appeal No. A/48/2018 | | ( Date of Filing : 06 Jan 2018 ) | | (Arisen out of Order Dated in Case No. CC/2062/2015 of District Bangalore 1st & Rural Additional) |
| | | | 1. Religare Health Insurance Co.Ltd. | | DGYS Global,
Plot No.A3,A4,A5, Sector 125,
Noida, Uttarpradesh-201301
Now Rep. by
Manager-Legal
M/s Religare Health Insurance Company India Ltd.,
Regd. Office (Then), D3,P3B,
Distric C3/enter, Saket,
New Delhi-110017
Alternatively:
Manager-Legal
M/s Religare Health Insurance Company India Ltd.,
Reg |
| ...........Appellant(s) | |
| Versus | | 1. S Kumar | | No.342, 7th Main,
ITI layout,
Malathahalli,
Near Ambedkar Institute of Technology,
Bengaluru-56 |
| ...........Respondent(s) |
|
|
| Final Order / Judgement | BEFORE THE KARNATAKA STATE CONSUMER DISPUTES REDRESSAL COMMISSION, BANGALORE
(ADDL. BENCH)
DATED THIS THE 4th DAY OF JULY 2022
PRESENT
MR. RAVISHANKAR : JUDICIAL MEMBER
MRS. SUNITA CHANNABASAPPA BAGEWADI : MEMBER
APPEAL NO. 48/2018
|
1.
|
Religare Health Insurance Co., Ltd., DGYS Global,
Plot No.A3, A4, A5,
Sector 125, Noida,
U.P. – 201 301.
|
……Appellant/s
|
|
2.
|
Religare Health Insurance Co., Ltd., Branch Office,
No.8, 2nd Floor, 1st Main,
80 Feet Road, S.T. Bed Area, Koramangala,
Bengaluru 560 034.
Now represented by
Manager – Legal,
M/s Religare Health Insurance Company India Ltd., Regd. Office (then):
D3, P3B, District CE/enter, Saket,
New Delhi 110 017.
Alternatively
Manager – Legal,
M/s Religare Health Insurance Company India Ltd., Regd. Office,
(Now) : 5th Floor, 19,
Chawla House,
Nehru Place,
New Delhi 110 019.
AND
M/s Religare Health Insurance Company India Ltd., Correspondence Office : Vipul Tech Square, Tower C,
Third Floor, Sector 43,
Golf Course Road, Gurgaon,
Haryana 122 009.
(By Sri H.N. Keshava Prashanth)
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|
V/s
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Sri S. Kumar,
Advocate, No.342,
7th Main, ITI Layout,
Malathahalli,
Near Ambedkar Institute of
Technology, Bengaluru 56.
(By Sri M.P. Srikanth)
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..…Respondent/s
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ORDER
MRS. SUNITA CHANNABASAPPA BAGEWADI, MEMBER
1. The appellant/complainant has preferred this appeal being aggrieved by the Order dt.28.09.2017 passed in CC.No.2062/2015 on the file of 1st Additional District Consumer Disputes Redressal Commission, Bangalore.
2. The brief facts of the case are as hereunder;
It is the case of the complainant that his son Harish Kumar taken the Health Insurance Policy bearing No.10046184 under the plan name CARE in the name of his father Sri S. Kumar and Mother Smt. Girija Kumar from the Opposite Parties by paying premium amount of Rs.23,920/- for an assured sum of Rs.5,00,000/- and the policy valid from 24.10.2013 to 24.10.2014. The complainant further alleged that the Opposite Parties offered the benefits to the insured such as hospitalization expenses, pre-hospitalization and post-hospitalization expenses, ambulance cover, organ done cover, domiciliary hospitalization, health checkup, second opinion charges and no claim bonus also offered tax benefits. The complainant took treatment for gastro problem, but, it was not cured and the doctor who treated him advised biopsy of ulcer and x-ray of chest. On 20.06.2014 he visited Health Care Global Enterprises and done NUSG of Thyroid and Microscopy, it was found that moderately differentiated squamous cell carcinoma left lateral tongue and MRI Neck was done on 24.06.2014. The complainant further alleged that he took treatment for Carcinoma Left Lateral Border of Tongue and spent Rs.2,38,262.17 for which the complainant submitted insurance claim to the Opposite Parties, but, surprisingly the Opposite Parties repudiated the claim vide letter dt.08.08.2014 on the ground of non-disclosure of material information at the time of proposal, but, the complainant further alleg
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