STATE CO N SU M E R D IS PUTES It E D R ESSALCO M M ISS I ON,O DISIIA, CUTTACK CONSUMER COMPLAINT NO. 1.9 OF 2018 Ranjan Mohapatra, aged about 68 years, S/o Late Radhakanta Mohapatra, Flat No.A /D - 7 - 1, Block - A Chandrama Housing Cornplex, Kharavela Nagar, Unit - 3, Bhubaneswar, Odisha Complainant Vrs.

Star Health & Allied lrtsurance Co.Ltd., Represented through its Authorised Signatory - Claims, No. l-5, Sri Sri Balaji Comptex, l-'t Floor, Whites Lane, Royapettah, Chennai - 600014 ... Opp.Party For the cornplainant : M/s R.l(.Pattnaik & Associates For the Opp.party : M/s N.C.Misra & Associates PRESENT:

HON,BLE DR. JUSTICE D.P.CHOUDHURY, PRESIDENT, DR P.K.PRUSTY, MEMBER AND MISS S.L.PATTNAIK, MEMBER fD,l {

DATED THE ogtn JULY , zozz ORDER DR. D.P. CHOUDHURY J., PRESIDENT The captioned complaint case is fited u/s LT of the consumer Protection Act (hereinafter called the 'Act' in short) by the complainant against'the opposite party seeking direction to the opposite party to pay a sum of Rs.3,2o,ooo/- along with all allied benefits with interest at the rate of LZ% per annum from the date of claim till the date of realisation, to pay Rs.25.00 lacs as compensation for causing loss of credibility, harassment and mental agony etc. along with litigation cost of Rs.25,000/- to the complainant.

FACTS

2.

The factual matrix leading to the case of the complainant is that the complainant being allured by the advertisement of the oP insurer has purchased the Medi-claim policy for sum assured of Rs.10.00 lacs u.nder the plan 'senior citizens Red carpet Health lnsurance policy' vide policy No.

Pl7oooo2lo1,/2o18l000106. The Policy was valid from 5.4.2afl to 4.4.2018. lt is alleged inter alia that the complainant while filling up of the proposal form. has admitted to have suffered from diabetic and hypertension. However, ofi 10.1.201g complainant having suffered from high fever got him admitted to the Apolto Hospital and after necessary treatment discharged on 18.1.2018. During hospitalisation, he has informed about his hospitalisation to the OP - insurer for cashless facitities. But the insurer raised the issue with regard to two more diseases i.e. Rheumatoid Arthritis and copD which he has not disclosed during filling up of the proposal form. Therefore, the op refused to provide cashless facilities but asked to submit documents to settle the medical expenses on reimbursement basis.

3.

lt is alleged by the complainant further that the op issued a letter on 14.2.20!8 to produce the treatment records and hospitalisation records qua his treatment at sAAoL Heart centre on 21'.5.201,6. The complainant alleged to. have replied on 2L.2.2018 that he was never treated by hospital at sAAoL Heart ,i ;., j

4 I

1 .1 Ii i Centre but he has taken the therapy for better health. He j i . neither got any medical treatment nor undergone any I I l hospitalisation at sAAoL Heart centre. lnstead of paying I I l attention to such letter, the OP remained silent. Then the I I complainant sent legal notice on 9.3.2018 to the Op and they 1 I I also replied on 24.3.201,8 through their advocate. However, on t 'I l

20.3.2018 the OP issued a letter of repudiation stating that they t I '

have called for additional informations with regard to SAAOL ,1 il j1 Heart Centre and the previous treatment etc. undergone by the :j i complainant, but due to non-submission of said clocuments, i ), there is clear violation of condition no.4.4 of policy in question

1 ,:i by the complainant for which they have repudiated the claim. i ;

Challenging the said repudiation the complainant filed the I l '

complaint alleging about deficiency in service and unfair trade li

1j :]

practice on the part of the Op. i, i t'i

4- fi OP filed written version admitting about purchase of i t Senior Citizens Red Carpet Health lnsurance Policy from them by .1 rr , . I . the complainant. lt is also admitted that the comptainant was i )rn i /v\

-, :, hospitalised on 10.1.2018 in Apollo Hospital and informed the oP for cashless fa