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United India Insurance Co Ltd. v/s Sandeep Kumar Bubna

Company & Directors' Information:- SANDEEP (INDIA) LTD [Active] CIN = L51491WB1982PLC035464

Company & Directors' Information:- KUMAR INSURANCE COMPANY LIMITED [Dissolved] CIN = U99999MH1943PTC004030

    First Appeal No. A/624 of 2016

    Decided On, 07 January 2020

    At, National Consumer Disputes Redressal Commission NCDRC

    By, MEMBER

    For the Appearing Parties: Varsha Chavan, Shyam Kondhalkar, Advocates.

Judgment Text

A.P. Bhangale, President

1. Heard submissions advanced by both the advocates at the Bar.

2. The appeal is preferred against the judgment and award dated 18/02/2016 passed in consumer complaint bearing no.309/13 by the learned Additional District Consumer Disputes Redressal Forum, Thane whereby award was passed in the sum of Rs.15 lacs together with interest @18% p.a. with effect from 03/02/2011 passed in consumer complaint no.309/2013 till realization. Apart from, compensation in the sum of Rs.50,000/- and litigation costs in the sum of Rs.10,000/- together with interest @18% p.a., if payment unpaid within 30 days from the date of order.

3. It is the grievance of the appellant that award is not only unreasonable, but excessive. Thus, it is submitted that disease noted for which the complainant undergoing medical treatment was known to the complainant, but suppressed from the appellant. It is further submitted that the complainant had also benefit of insurance policy from another insurance company i.e. Oriental Insurance Company Ltd. for Rs.4,53,079/-. The claim against the present appellant was in the sum of Rs.15 lacs for the expenses incurred by the complainant on hospitalization and medical treatment. The claim was repudiated on 03/02/2011 by the appellant on the ground that the ailment Myasthenia gravis was pre-existing disease and therefore claim was not tenable. However, there was no documentary evidence to substantiate this ground in appeal that it was pre-existing disease and was known to the complainant as the opponent to avoid the liability ought to have brought material on record to substantiate the ground in appeal. Considering the insurance cover for the complainant, in our view, bearing in mind the nature of Mediclaim policy, the complainant was entitled to claim the expenses which he had incurred towards hospitalization and medical treatment. However, when the complainant had chosen to avail benefits from more than two insurers in this case, the complainant has already received a sum of Rs.4,53,079/- from Oriental Insurance Co.Ltd., we must consider deducting the said sum from sum of Rs.15 lacs award which is insurance cover in this case. We, therefore, award the sum of Rs.15 lacs minus the amount already received since in our opinion the insurance policy is for reimbursement of the medical treatment expenses and not for to claim lottery or strike a jackpot. On the basis of said principle, we are also inclined to reduce the interest award as in our view interest @9% p.a. would be just and reasonable to be awarded in such cases. Therefore, impugned order is modified to the effect that the complainant shall receive an amount of Rs.15,00,000/- ( ) Rs.4,53,079/- = Rs.10,46,921/- from the appellant (opponent). The amount shall be payable @9% p.a. as directed by the learned District Forum w.e.f.03/02/2011 until realization including compensation and costs as already awarded which shall also be pay

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able @ 9% p.a. 4. Amount which was already deposited by the opponent insurance company shall be allowed to be withdrawn by the complainant accordingly, but surplus, if any, shall be refunded to the appellant. 5. Award is modified accordingly and appeal is disposed off as partly allowed. No order as to costs.