| First Appeal No. A/2222/2011 | | ( Date of Filing : 26 Jul 2011 ) | | (Arisen out of Order Dated 28/04/2011 in Case No. CC/2887/2010 of District Bangalore 3rd Additional) |
| | | | 1. The Manager, The New India Assurance Co. Ltd. | | Eshwari Complex
NO. 65, 1st Floor
80 Ft Road, Rajajinagar
Bangalore 560010 | | 2. The Manager | | Medi Assist India Pvt. Ltd.
No. 797, Annapoorna
10th Main, 4th Block
Jayanagar, Bangalore 560011
Both are represented by
The New India Assurance Co. Ltd.
Divisional Office III Mahalakshmi
Chambers, | | II Floor, NO. 9 .2 M.G. Road, Bangalore 560001 | | by its Duly Constituted Attorney |
| ...........Appellant(s) | |
| Versus | | 1. B. Shubha | | R/at No. 1094, 1st Floor
'Bairaveshwra Nilaya'
15th Main, Srinagara
Bangalore 560019
. |
| ...........Respondent(s) |
|
|
| Final Order / Judgement | BEFORE THE KARNATAKA STATE CONSUMER DISPUTES REDRESSAL COMMISSION, BANGALORE.
DATED THIS THE 8th DAY OF APRIL 2022
PRESENT
MR. RAVISHANKAR : JUDICIAL MEMBER
MRS. SUNITA CHANNABASAPPA BAGEWADI : MEMBER
APPEAL No. 2222/2011
|
1.
|
The Manager,
The New India Assurance Co. Ltd., Eshwari
Complex, No.65, 1st Floor,
80 Feet Road,
Rajajinagar,
Bangalore 560 010.
|
……Appellant/s
|
|
2.
|
The Manager,
Medi Assist India Pvt. Ltd., No.797,
“Annapoorna”, 10th Main,
4th Block, Jayanagar,
Bangalore 560 011.
Both are represented by
The New India Assurance
Co., Ltd., Divisional
Office – III, Mahalakshmi
Chambers, 2nd Floor,
No.9/2, M.G. Road,
Bangalore 560 001,
By its Duly Constituted Attorney.
(By Sri C.R. Ravishankar)
|
|
V/s
|
Smt. B. Shubha, Major,
R/at No.1094, 1st Floor,
“Bairaveshwara Nilaya”,
15th Main, Srinagara,
Bangalore 560 019.
(By Sri K.S. Mohith Kumar)
|
…Respondent/s
|
ORDER
MRS. SUNITA CHANNABASAPPA BAGEWADI, MEMBER
1. The appellant/Opposite Party has preferred this appeal being aggrieved by the Order dt.28.04.2011 passed in CC.No.2887/2010 on the file of 3rd Additional District Consumer Disputes Redressal Commission, Bangalore.
2. The brief facts of the complaint are hereunder;
It is the case of the complainant that she has obtained mediclaim policy from the Opposite Party No.1 for a period from 11.01.2010 to 10.01.2011. The complainant’s son Kushal was the beneficiary under the policy. The complainant’s son was admitted to the Yogananda Hospital on 08.03.2010 for acute appendicitis and he was operated for the same and the complainant incurred medical expenses of Rs.29,945/-. The request for the complainant for cashless facility was not considered by the Opposite Party. The Opposite Party rejected the claim of the complainant without any valid reason by letter dt.15.04.2010 stating that the illness of the complainant’s son is a pre-existing disease under clause-4.1 of the policy and they repudiated the claim. The complainant issued notice dt.03.08.2010 and the Opposite Party replied it on 14.09.2010 contending that the illness of the complainant’s son was pre-existing since two months and it has come to their knowledge vide their internal investigators who had verified their indoor records, hence, the claim was repudiated.
3. After service of notice, the Opposite Party has filed version contending that after receiving the claim of the complainant, the Opposite Party got verified the authenticity of the claim and obtained the indoor case records and found that the ailment of Kushal was pre-existing i.e., he underwent diagnosis for the said ailment in the month of January 2010 and subsequently he has taken the insurance policy by suppressing the pre-existing ailment. Hence, the insurance policy does not cover the risk of pre-existing ailment as per the exclusion clause 4.1. Hence, the claim was repudiated as per the terms of the policy and there is no deficiency in service.
4.
| |
Back
