BEFORE THE TELANGANA STATE CONSUMER DISPUTES REDRESSAL COMMISSION : HYDERABAD. FA.NO.546 OF 2022 AGAINST ORDERS IN CC.NO.157 OF 2019, DISTRICT CONSUMER COMMISSION, RANGA REDDY Between:

P.Saraswathi Kumar, S/o.P. Madana Chary, Aged about 44 years, Occ: Private Service, R/o.4-74/1, Vikas Nagar, Dilsukhnagar, Hyderabad – 500 060.

……Appellant/Complainant And:

1. Star Health and Allied Insurance Co.Ltd., Regd. Corporate Office-1, New Tank Street, Valluvar Kottam High Road, Nungambakkam, Chennai – 600 034 Rep. by its Authorized Signatory.

2. Star Health and Allied Insurance Co.Ltd., D.No.11-13-1372, 3rd Floor, Main Road, Above More Mega Store, Beside Astha Laxmi Kaman, Dwarakapuri, Kothapet, Hyderabad -35.

Rep. by its Authorized Signatory.

……Respondents/Opp.Parties Counsel for the Appellant/Complainant: M/s.K.Visweswara Rao Counsel for the Respondents/Opp.Parties: Sri GSG Radhakrishna QUORAM:

HON’BLE SMT.JUSTICE DR.G.RADHA RANI ……PRESIDENT &

HON’BLE SMT.MEENA RAMANATHAN ……MEMBER (NON-JUDICIAL)

WEDNESDAY, THE ELEVENTH DAY OF MARCH TWO THOUSAND TWENTY SIX ******

Order: (Per Smt.Dr.G.Radha Rani, Hon’ble President)

1. This appeal is filed by the Complainant aggrieved by the order of District Consumer Commission, Ranga Reddy at L.B.Nagar in CC.No.157/2019 dated 09.03.2022 for dismissing the complaint filed by him.

2. For the sake of convenience, the parties are hereinafter referred as arrayed before the District Commission as Complainant and Opposite Parties.

3. (a) The case of the Complainant was that, he had taken “Family Health Optima Policy” to cover the health risks of his entire family members, believing the version of the agent V.Chandra Shaker that the policy was very useful to him and his family members and that the premium was also very less with high coverage. The policy was taken for an amount of Rs.3,00,000/- to all the family members of Complainant for the period from 31.05.2012 to 30.05.2013. An amount of Rs.8,624/- was paid as premium at that time. The policy was renewed for the second time on 27.05.2013. For the third time on 31.05.2014. For the fourth time on 07.05.2015 the claim amount was enhanced from Rs.3,00,000/- to Rs.5,00,000/- and the premium amount from Rs.8,624/- to Rs.13,342/-. Again on 24.05.2016, the insurance coverage was enhanced from Rs.5,00,000/- to Rs.15,00,000/- by paying premium of Rs.29,495/-. On 16.05.2017, the Complainant received a letter from the Opposite Party that the policy would not be renewed for his wife due to non-disclosure of material facts. But on 07.06.2017, the agent of the Opposite Party collected the cheque for Rs.29,495/- covering the entire family members for Rs.15,00,000/-. But subsequently took only Rs.23,184/- out of Rs.29,495/- and transferred the remaining amount to the Complainant’s account.

(b) The Complainant submitted that when he took the policy on 31.05.2012, there was no problem suffered by his wife. On 20.11.2012, his wife suddenly suffered with ankle pain and headache and they approached the doctor. The doctor after examining her prescribed some medicines. Again on 21.12.2012, the doctor prescribed some lab tests. After seeing the test reports, the doctor expressed suspicion of chronic kidney disease which may require dialysis and referred to C.C. Shroff Hospital, Kachiguda for further management. The Opposite Party without seeing proper documentation rejected the renewal on the said ground. The Complainant submitted the dialysis bills of C.C. Shroff Hospital time to time to the Opposite Party. On the advice of the doctors, his wife Smt.P.Vikranthi was admitted at Star Hospital, Banjara Hills for cadaveric renal transplantation on 02.03.2017. When the Complainant made a representation for pre- authorization approval to the Opposite Party, they raised some query on pre-authorization and requested the Complainant to send some more documents. Though the Complainant submitted all the required documents to the Opposite Party, they did not respond. The Complainant frequently followed