STATE CONSUMER DISPUTES REDRESSAL COMMISSION KERALA FIRST APPEAL NO. SC/32/A/15/311 STAR HEALTH AND ALLIED INSURANCE CO LTD PRESENT ADDRESS - KRM CENTRE, VI FLOOR, NO 2, HARRINGTON ROAD, CHETPET ,CHENNAI 600031 ,KERALA.

.......Appellant(s)

Versus RONIVAS PRESENT ADDRESS - ROBINS HOUSE, THAZHE ARAPPETTA, MEPPADI POST, VYTHIRI TALUK, WAYANAD ,KERALA.

STAR HEALTH AND ALLIED INSURANCE CO LTD PRESENT ADDRESS - BRANCH OFFICE, WAYANAD, KALPETTA ,KERALA.

.......Respondent(s)

BEFORE:

SRI.RADHAKRISHNAN.K.R , PRESIDING MEMBER FOR THE APPELLANT:

NEMO FOR THE RESPONDENT:

NEMO DATED: 29/07/2025

ORDER

KERALA STATE CONSUMER DISPUTES REDRESSAL COMMISSION VAZHUTHACAUD, THIRUVANANTHAPURAM APPEAL No.311/2015 JUDGMENT DATED: 29.07.2025 (Against the order in C.C.No.204/2012 on the files of DCDRC, Wayanad)

PRESENT:

HON’BLE JUSTICE SRI. B. SUDHEENDRA : PRESIDENT KUMAR SRI. AJITH KUMAR D. : JUDICIAL MEMBER SRI. K.R. RADHAKRISHNAN : MEMBER APPELLANTS:

1.

Star Health & Allied Insurance Company Limited, KRM Centre, VI Floor, No.2, Harrington Road, Chetpet, Chennai – 600 031

2.

Star Health & Allied Insurance Company Limited, Branch Office, Kalpetta, Building No.187(7), Ammu’s Complex, Kalpetta, Wayanad – 673 121 (by Adv. G.S. Kalkura)

Vs.

RESPONDENT:

Ronivas, Robins House, Thazhe Arappetta, Meppadi Post, Vythiri Taluk, Wayanad (by Adv. R. Suja Madhav)

JUDGMENT

SRI. K.R. RADHAKRISHNAN: MEMBER This is an appeal filed under section 15 of the Consumer Protection Act, 1986, by the opposite parties against the order dated 16.01.2015 in C.C.No.204/2012 on the files of the District Consumer Disputes Redressal Commission, Wayanad (for short ‘the District Commission’). As per the order, the District Commission partly allowed the complainant and directed the opposite party to pay the claim amount of Rs.1,30,000/-(Rupees One Lakh Thirty Thousand only) with 12% interest from the date of filing the complaint till payment. They were also directed to pay Rs.2,000/- (Rupees Two Thousand only) as compensation and Rs.1,000/-(Rupees One Thousand only) as costs of the proceedings within 30 days from the date of receipt of the order.

The opposite parties challenge the said order.

2. The brief details of the complaint are as follows:

The complainant had taken a Medi Classic Insurance Policy (Individual) from the opposite party on 30.07.2009 which was continuously renewed without any break for three years. At the time of expiry of the third policy No. P 181314/01/2012/001660 for the period from 30.07.2011 to 29.07.2012, the nd complainant approached the 2 opposite party for renewal of the policy. However, they refused to accept the premium to renew the policy and so he had to take the policy from another insurance company. According to the complainant he had pain on the right side of the hip at the end of the first policy period and he thought that it was due to muscular pain and he had taken conventional treatment like balm, oil massage etc for the ailment. After two years it was diagnosed as Secondary Osteo Arthritis (R) Hip and surgery was the only remedy. During the third policy period, the complainant had undergone treatment at the Medical College Hospital, Thiruvananthapuram for Secondary Osteo Arthritis (R) Hip and undergone surgery. The treatment certificate and all other documents and bills for Rs.1,30,000/(Rupees One Lakh Thirty Thousand only) were submitted to the insurance company for reimbursement. However, they repudiated the claim vide letter dated 16.01.2012 on the ground of pre-existing disease. According to the complainant his ailment was not a pre-existing disease and hence the he is entitled for getting the reimbursement of the treatment expenses. The repudiation of the claim amounts to deficiency in service on the part of the opposite parties and hence he filed the complaint claiming Rs.1,30,000/-(Rupees One Lakh Thirty Thousand only) towards treatment expenses with compensation and costs. 3. Notice was issued to the opposite parties who entered appearance and filed their version