BEFORE THE TELANGANA STATE CONSUMER DISPUTES REDRESSAL COMMISSION : HYDERABAD.

F.A.No.1000 OF 2024 AGAINST ORDERS IN C.C.08/2024 DISTRICT CONSUMER COMMISSION-II, HYDERABAD Between:

Star Health and Allied Insurance Co., Ltd., # No.1, New Tank Street Valluvarkottam High Road, Nungambakkam, Chennai – 600 034 NA-3, Rep. by its Managing Director, And also at Regional Office, 1-8-167 to 179/2/C, 3rd Floor, Usha Kiran Complex, S.D.Road, Secunderabad-500 003, Rep. by its Regional Manager.

………..Appellant/ Opposite Party And:

Mr.Bojja Venkata Ratna Kumar, R/o Flat No.105, Syymphonyroyale, H.No.3-4-423/424, Narayanaguda, Beside Metro Station, Hyderabad, Ph.No.8374799996.

……..Respondent/Complainant Counsel for the Appellant/Opposite Party : M/s G.S.G. Radha Krishna.

Counsel for the Respondent/Complainant : M/s Ganu & Co., QUORUM :

HON’BLE SMT. MEENA RAMANATHAN, I/c PRESIDENT &

HON’BLE SRI. V.V.SESHUBABU, MEMBER – (JUDICIAL)

MONDAY, THE 10^th D AY OF NOVEMBER TWO THOUSAND TWENTY FIVE **********

Order : PER HON’BLE SRI. V.V.SESHUBABU, MEMBER – JUDICIAL

1. The appeal is filed U/s 41 of Consumer Protection Act, 2019 by the Opposite Party, aggrieved by the order of District Consumer Commission-II, Hyderabad, dated 05.11.2024 in CC 08/2024, where under the opposite party was directed to continue to provide the services and facilities under the subject policy till the same is in force as the letter, dated 27.07.2023 issued by opposite party repudiating the claim by cancelling the policy No.P/161130/01/2022/016267 (corrected as per memo filed by the counsel for the complainant, dated 10.09.2024), is illegal and void which is not binding on the complainant; to pay Rs.50,000/- as compensation; to pay costs of Rs.10,000/-. Time for compliance is 45 days from the date of receipt of the order.

2. The brief averments of the complaint are that the opposite party is a well reputed insurance Company, recruits agents who are supposed to bring in customers by way of advertising the benefits of various insurance policies provided by their Company, in pursuance of such policy, that they approached the complainant in the year 2018; that they have offered coverage to the health and life of the complainant; that when the complainant informed about his pre-existing disease, the opposite party has assured him that by paying 1.5 times more to the regular premium amount i.e. Rs.64,200/-, the waiting period of Pre-existing disease will be reduced to one year from three years from the date of inception of medical policy; that the complainant has obtained policy vide No.P/161130/01/2022/016267, on 04.05.2021, that covers the medical risk for Rs.10,00,000/- and paid the premium amount of Rs.96,300/- for both the complainant and his wife; that policy was renewed for the period from 04.05.2022 to 03.05.2023 in the second year vide P/16110/01/2023/012344, by paying premium amount of Rs.67,579/-; that the opposite party advised that, if policy is renewed for 03 years, the premium will not increase and he can pay it in 06 half yearly equal installments of Rs.43,083/-, and in the event of hospitalization, the medical bill will be adjusted towards balance insurance premium pending at the time of medical insurance claim and the balance will be remitted to the insured, as such he renewed the policy for 03 years from

04.05.2023 to 03.05.2026 with a premium amounting to Rs.2,58,498/- vide Policy No. P/161130/01/2024/007588 and also paid 1^st installment amount of Rs.43,043/- on 06.04.2023 and 2^nd installment on 03.11.2023.

3. That on 14.06.2023, the complainant suffered acute abdominal pain and the consulted doctor, examined and was diagnosed with “Cholecystitis” and suggested to undergo immediate surgery, so he joined in the Apollo Hospital, Secunderabad on 20.06.2023; that the complainant registered for cashless medical insurance coverage with claim intimation No. CIR/2024/161130/0382135 on 23.06.2023 and the same was rejected by the opposite party on the ground that “Installment amount due is